=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639933658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY QUINN MCFARLIN NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2024
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 890 W 4TH ST
-----------------------------------------------------
City | BENSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85602-6437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-586-3664
-----------------------------------------------------
Fax | 520-586-7283
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10280 N KRAUSWOOD LN
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85737-6936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-810-0866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 302523
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------