Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Boontung

Individual provider Family Nurse Practitioner · NPI 1790567816

Mary Boontung is a Nurse Practitioner in Gilbert, Arizona. Qualified in 2023, 3 years ago. Practices with Ponderosa Heart House Call, an 11-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
3
Licensed in
AZ
In the registry since
2023
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Practice location Address checks out

3458 E Casa Mader Dr
Gilbert, AZ 85298-4202
Phone: (310) 989-9710
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 220096 (AZ)

Record details

NPI number1790567816
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 16, 2023
Last updated in NPPESOctober 16, 2023
Certification dateOctober 15, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Ponderosa Heart House Call — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Gilbert