Healthcare Provider Details

I. General information

NPI: 1285974238
Provider Name (Legal Business Name): MARY FRANCES MISIAK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BOETTCHER FNP-BC

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2927 N 7TH AVE
PHOENIX AZ
85013-4102
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3153
  • Fax: 602-406-7176
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4855
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP4855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: