Provider Demographics
NPI:1053914564
Name:NDUNGU, SYMONPETER (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SYMONPETER
Middle Name:
Last Name:NDUNGU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 E SUNDANCE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9643
Mailing Address - Country:US
Mailing Address - Phone:469-452-9408
Mailing Address - Fax:
Practice Address - Street 1:4139 E SUNDANCE AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9643
Practice Address - Country:US
Practice Address - Phone:469-452-9408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1019825363LP0808X
OR100166290363LP0808X
TX1019825363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty