Active NPI
Mary Gdula, FNP
- Family Nurse Practitioner
- Grand Canyon, AZ
National Provider Identifier
1124092242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP1443
- Practice address
- 1 Clinic Road
Grand Canyon, AZ 86023 - Phone
- (928) 213-6121
- Fax
- (928) 213-6136
- NPI assigned
- Feb 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN116942 | AZ | |
| Family Nurse Practitioner | 363LF0000X | AP1443 | AZ | Primary |
Addresses
Primary practice location
1 Clinic Road
Grand Canyon, AZ 86023
Mailing address
PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 233-5110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 764755 | Other | AZ | AHCCCS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN116942 | AZ | MD | Registered Nurse |
| AP1443 | AZ | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Horizon Healthcare | Family | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382400000000",
"number": "1124092242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3630",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860033630",
"telephone_number": "928-233-5110",
"fax_number": "928-774-6687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CLINIC ROAD",
"city": "GRAND CANYON",
"state": "AZ",
"postal_code": "86023",
"telephone_number": "928-213-6121",
"fax_number": "928-213-6136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GDULA",
"first_name": "MARY",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2013-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "AZ",
"license": "RN116942",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "AP1443",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS",
"identifier": "764755",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Canyon, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.