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General NPI Number Information
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NPI Number | 1164425450
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Entity Type | Organization
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Legal Business Name | A NEW CREATION WOMENS CLINIC PC
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 3055 W INA RD BLDG 12, SUITE 195
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City | TUCSON
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State | AZ
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Zip | 85741-2107
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Country | US
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Telephone | 520-293-1117
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Fax | 520-293-7701
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Provider Business Mailing Address
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Address Line | 3055 W INA RD BLDG 12, SUITE 195
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City | TUCSON
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State | AZ
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Zip | 85741-2107
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Country | US
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Telephone | 520-293-1117
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Fax | 520-293-7701
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARY-LOUISE MULCAHY
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Credential | RN, MBA, BSN
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Telephone | 480-357-3904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 86
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 86
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3090
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License Number State | AZ
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