Healthcare Provider Details

I. General information

NPI: 1164425450
Provider Name (Legal Business Name): A NEW CREATION WOMENS CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 W INA RD BLDG 12, SUITE 195
TUCSON AZ
85741-2107
US

IV. Provider business mailing address

3055 W INA RD BLDG 12, SUITE 195
TUCSON AZ
85741-2107
US

V. Phone/Fax

Practice location:
  • Phone: 520-293-1117
  • Fax: 520-293-7701
Mailing address:
  • Phone: 520-293-1117
  • Fax: 520-293-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3090
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number86
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number86
License Number StateAZ

VIII. Authorized Official

Name: MARY-LOUISE MULCAHY
Title or Position: ADMINISTRATOR
Credential: RN, MBA, BSN
Phone: 480-357-3904