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General NPI Number Information
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NPI Number | 1538283650
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Entity Type | Individual
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Provider Name | MARY TAPIA FNP/CNM
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 3132 STIX RD
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City | LAKESIDE
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State | AZ
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Zip | 85929-6917
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Country | US
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Telephone | 505-870-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 3132 STIX RD
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City | LAKESIDE
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State | AZ
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Zip | 85929-6917
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Country | US
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Telephone | 505-870-7879
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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 | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number | RN155657
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN155657
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN155657
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | RN155657
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License Number State | CA
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