Healthcare Provider Details

I. General information

NPI: 1376595843
Provider Name (Legal Business Name): GEORGETTE MEHALIK PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGETTE M MISIEWICZ APRN

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 S CAMPBELL AVE
GREEN VALLEY AZ
85614-0504
US

IV. Provider business mailing address

1260 S CAMPBELL AVE
GREEN VALLEY AZ
85614-0504
US

V. Phone/Fax

Practice location:
  • Phone: 520-407-5600
  • Fax: 520-407-5990
Mailing address:
  • Phone: 520-407-5600
  • Fax: 520-407-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP6435
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number034561-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: