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NPI Code Detail

MEDICARE: MS. GEORGETTE MEHALIK APRN

MEDICARE: MS. GEORGETTE MEHALIK APRN
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
1363LP0200XPediatric Nurse Practitioner034561-23NH
2363LP0200XPediatric Nurse PractitionerAP6435AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376595843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GEORGETTE MEHALIK APRN
Provider Business Mailing Address
First Line : PO BOX 188
Second Line :
City : MARANA
State : AZ
Zip : 85653-0188
Country : US
Telephone Number : 520-682-4111
Fax Number : 520-818-3630
Provider Business Practice Location Address
First Line : 13395 N MARANA MAIN ST
Second Line :
City : MARANA
State : AZ
Zip : 85653-7008
Country : US
Telephone Number : 520-682-4111
Fax Number : 520-682-3817
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 02/27/2018

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