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General NPI Number Information
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NPI Number | 1669608717
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Entity Type | Organization
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Legal Business Name | PAX ET BONUM FAMILY PRACTICE
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 1820 E BELL DE MAR DR APT N206
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City | TEMPE
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State | AZ
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Zip | 85283-4295
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Country | US
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Telephone | 480-236-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 1820 E BELL DE MAR DR APT N206 N206
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City | TEMPE
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State | AZ
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Zip | 85283-4295
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Country | US
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Telephone | 480-236-7330
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Fax |
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Authorized Official
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Title or Position | OWNER, FAMILY NURSE PRACTITIONER
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Name | MARILYNN MULHERON
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Credential | NP
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Telephone | 480-236-7330
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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 | 102313
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License Number State | AZ
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