Individual
MARY BOONTUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3458 E CASA MADER DR, GILBERT, AZ 85298-4202
(310) 989-9710
Mailing address
3458 E CASA MADER DR, GILBERT, AZ 85298-4202
(310) 989-9710
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
220096
AZ
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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