Individual provider Active NPI

Mallory Guderian, RN BSN

  • School Registered Nurse
  • Chandler, AZ
National Provider Identifier
1770396947
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
264230 Issued in AZ
Practice address
1600 W Queen Creek Rd
Chandler, AZ 85248-3003
Phone
(480) 883-5502
NPI assigned
Jan 30, 2025
Last updated
Jan 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X 264230 AZ Primary

Addresses

Primary practice location

1600 W Queen Creek Rd
Chandler, AZ 85248-3003

Mailing address

1600 W Queen Creek Rd
Chandler, AZ 85248-3003

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)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
264230AZMDSchool Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738195200000",
    "number": "1770396947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W QUEEN CREEK RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852483003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W QUEEN CREEK RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852483003",
            "telephone_number": "480-883-5502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDERIAN",
        "first_name": "MALLORY",
        "credential": "RN BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "AZ",
            "license": "264230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.