Healthcare Provider Details

I. General information

NPI: 1235683640
Provider Name (Legal Business Name): MARY WHITNEY B WISCHKI RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 E ERICKSON DR STE 100
TUCSON AZ
85712-2809
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-324-7200
  • Fax:
Mailing address:
  • Phone: 520-324-4100
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: