Individual
MARY GDULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1 CLINIC ROAD, GRAND CANYON, AZ 86023
(928) 213-6121
(928) 213-6136
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 233-5110
(928) 774-6687
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN116942
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP1443
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
764755
AHCCCS
AZ
Enumeration date
02/15/2006
Last updated
10/22/2013
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