Healthcare Provider Details

I. General information

NPI: 1184656902
Provider Name (Legal Business Name): CHRISTINE MARIE MULLIGAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE MARIE MULLIGAN N.P.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

1727 W STEINWAY DR
PHOENIX AZ
85041-9122
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-200-6028
Mailing address:
  • Phone: 602-943-6807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN 23616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: