Healthcare Provider Details

I. General information

NPI: 1679876031
Provider Name (Legal Business Name): MARIANNE N PARHAM RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 W SAINT MARYS RD STE 205
TUCSON AZ
85745-2615
US

IV. Provider business mailing address

1707 W SAINT MARYS RD STE 205
TUCSON AZ
85745-2615
US

V. Phone/Fax

Practice location:
  • Phone: 520-624-0888
  • Fax: 520-624-0091
Mailing address:
  • Phone: 520-624-0888
  • Fax: 520-624-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8610
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAP8610
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN086463
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: