MEDICARE: A NEW CREATION WOMENS CLINIC PC

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	363LW0102X	Women's Health Nurse Practitioner	86	AZ
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	86	AZ
3	207Q00000X	Family Medicine Physician	3090	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164425450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A NEW CREATION WOMENS CLINIC PC

Provider Business Mailing Address
First Line	:	3055 W INA RD
Second Line	:	BLDG 12, SUITE 195
City	:	TUCSON
State	:	AZ
Zip	:	85741-2107
Country	:	US
Telephone Number	:	520-293-1117
Fax Number	:	520-293-7701

Provider Business Practice Location Address
First Line	:	3055 W INA RD
Second Line	:	BLDG 12, SUITE 195
City	:	TUCSON
State	:	AZ
Zip	:	85741-2107
Country	:	US
Telephone Number	:	520-293-1117
Fax Number	:	520-293-7701

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARY-LOUISE MULCAHY
Credential	:	RN, MBA, BSN
Telephone Number	:	480-357-3904

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	11/14/2012

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