Healthcare Provider Details

I. General information

NPI: 1699986919
Provider Name (Legal Business Name): JANET H. MAR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 E BROADWAY BLVD SUITE A-100
TUCSON AZ
85711-3640
US

IV. Provider business mailing address

3190 N SWAN RD
TUCSON AZ
85712-1227
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-4906
  • Fax: 520-795-0225
Mailing address:
  • Phone: 520-547-9700
  • Fax: 520-547-9719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN 935642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: