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General NPI Number Information
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NPI Number | 1497575039
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Entity Type | Individual
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Provider Name | MARY ELIZABETH MYLCHREEST APRN (FNP-C)
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Gender | Female
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 19829 N 27TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-4001
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Country | US
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Telephone | 623-879-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 19636 N 27TH AVE STE 408
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City | PHOENIX
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State | AZ
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Zip | 85027-4021
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Country | US
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Telephone | 623-780-0100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 317303
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 163WG0100X
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Taxonomy Name | Gastroenterology Registered Nurse
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License Number | RN203810
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License Number State | AZ
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