Healthcare Provider Details

I. General information

NPI: 1114871092
Provider Name (Legal Business Name): MARY MAICHL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 N 24TH ST STE 300
PHOENIX AZ
85016-9107
US

IV. Provider business mailing address

4211 E PALM LN UNIT 107
PHOENIX AZ
85008-3128
US

V. Phone/Fax

Practice location:
  • Phone: 602-702-2536
  • Fax: 602-702-2536
Mailing address:
  • Phone: 602-702-2536
  • Fax: 602-702-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number331784
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: