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General NPI Number Information
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NPI Number | 1356038053
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Entity Type | Organization
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Legal Business Name | MISHAUN PLLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 3640 HIGHWAY 95 STE 100
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-4336
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Country | US
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Telephone | 702-339-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 2865 GRANDHILL RD
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City | BULLHEAD CITY
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State | AZ
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Zip | 86442-8512
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Country | US
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Telephone | 702-339-7688
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISHAUN FRANCES NEWMAN
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Credential | FNP-C
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Telephone | 702-339-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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