MEDICARE: MRS. NANCY B MULLINS FNP

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	363LF0000X	Family Nurse Practitioner	AP1485	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	Z182571	OTHER	AZ	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134291321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY B MULLINS FNP

Provider Business Mailing Address
First Line	:	202 E EARLL DR
Second Line	:	SUITE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2634
Country	:	US
Telephone Number	:	602-808-2800
Fax Number	:	602-808-2799

Provider Business Practice Location Address
First Line	:	262 E UNIVERSITY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-5932
Country	:	US
Telephone Number	:	602-808-2800
Fax Number	:	602-808-2799

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	09/07/2016

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