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General NPI Number Information
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NPI Number | 1942985114
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Entity Type | Individual
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Provider Name | MARY BIJU MSN-FNP -C
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 4330 E UNIVERSITY DR
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City | MESA
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State | AZ
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Zip | 85205-7004
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Country | US
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Telephone | 480-218-3280
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Fax | 480-324-2463
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Provider Business Mailing Address
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Address Line | 5099 W DOBBINS RD
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City | LAVEEN
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State | AZ
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Zip | 85339-9733
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Country | US
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Telephone |
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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 | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN139148
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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 | 293860
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License Number State | AZ
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