MEDICARE: NARISSA JOY WHITELAW DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OT014006	PA
2	207Q00000X	Family Medicine Physician	006414	AZ

General Provider Information

NPI Number	:	1023304250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARISSA JOY WHITELAW DO

Provider Business Mailing Address
First Line	:	4801 E BROADWAY BLVD STE 251
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3633
Country	:	US
Telephone Number	:	520-382-1205
Fax Number	:	520-795-0225

Provider Business Practice Location Address
First Line	:	2260 N ROSEMONT BLVD STE 107
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-2137
Country	:	US
Telephone Number	:	520-318-1033
Fax Number	:	520-318-1338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	04/07/2026

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