Healthcare Provider Details

I. General information

NPI: 1063814879
Provider Name (Legal Business Name): NANCY MUCHA CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2843 N 89TH ST
MESA AZ
85207-4278
US

IV. Provider business mailing address

201 W GUADALUPE RD STE 200
GILBERT AZ
85233-3327
US

V. Phone/Fax

Practice location:
  • Phone: 480-396-3482
  • Fax:
Mailing address:
  • Phone: 480-219-6631
  • Fax: 480-247-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP7292
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP7292
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: