Individual
MISTY AUTUMN MCGILLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
3939 S PARK AVE, TUCSON, AZ 85714-1635
(520) 333-4320
Mailing address
4575 E BROADWAY BLVD, TUCSON, AZ 85711-3509
(520) 325-4268
(520) 318-6935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 175929
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP9889
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235041
—
AZ
Enumeration date
04/02/2015
Last updated
07/21/2022
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