Individual
MACELINE CHECK CHECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3295 W INA RD STE 150, TUCSON, AZ 85741-2192
(207) 444-3765
Mailing address
1161 N EL DORADO PL STE 203, TUCSON, AZ 85715-4607
(520) 570-1460
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
290143
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
67107
NM
363LP1700X
Perinatal Nurse Practitioner
1073322
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
212430
—
AZ
Enumeration date
02/13/2023
Last updated
06/18/2024
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