Healthcare Provider Details

I. General information

NPI: 1790885507
Provider Name (Legal Business Name): CAROLYN MARIE MACHOLD CNS,CRNFA,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E CALLE MARIPOSA
TUCSON AZ
85718-2952
US

IV. Provider business mailing address

PO BOX 42123
TUCSON AZ
85733-2123
US

V. Phone/Fax

Practice location:
  • Phone: 520-318-6039
  • Fax: 520-320-0081
Mailing address:
  • Phone: 520-318-6039
  • Fax: 520-320-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number026
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN040651
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number042232
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: