Healthcare Provider Details

I. General information

NPI: 1083860647
Provider Name (Legal Business Name): MARY K HARTY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E UNIVERSITY DR
TEMPE AZ
85281-5391
US

IV. Provider business mailing address

PO BOX 5199
ABILENE TX
79608-5199
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-3346
  • Fax: 480-965-8914
Mailing address:
  • Phone: 866-890-6390
  • Fax: 325-437-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP3097
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: