MEDICARE: MARY LYNN MINERS N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN089032	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003857301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LYNN MINERS N.P.

Provider Business Mailing Address
First Line	:	1760 E RIVER RD
Second Line	:	350
City	:	TUCSON
State	:	AZ
Zip	:	85718-5999
Country	:	US
Telephone Number	:	520-519-7720
Fax Number	:	520-519-5181

Provider Business Practice Location Address
First Line	:	6565 E CARONDELET DR
Second Line	:	STE 155
City	:	TUCSON
State	:	AZ
Zip	:	85710-3587
Country	:	US
Telephone Number	:	520-886-0206
Fax Number	:	520-886-0829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/30/2012

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