Basic Information
| Provider Information | |||||||||
| NPI: | 1366112120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUNSALUS | ||||||||
| FirstName: | HARDY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4605 E ELWOOD ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850401978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802561518 | ||||||||
| FaxNumber: | 4803043446 | ||||||||
| Practice Location | |||||||||
| Address1: | 4605 E ELWOOD ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850401978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802561518 | ||||||||
| FaxNumber: | 4803043446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2021 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R0098706 | OK | N | Nursing Service Providers | Registered Nurse | 367500000X | 268241 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.