Individual provider Active NPI

Mary L Brown, NP

  • Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1295774933
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN057171 Issued in AZ
Practice address
5981 E. Grant Rd.
Ste 155
Tucson, AZ 85712
Phone
(520) 886-5315
Fax
(520) 298-8204
NPI assigned
Jun 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN057171 AZ Primary

Addresses

Primary practice location

5981 E. Grant Rd.
Ste 155
Tucson, AZ 85712

Mailing address

PO Box 43100
Tucson, AZ 85733
Phone (520) 722-3777

Other identifiers 1

IdentifierTypeStateIssuer
880460MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071010000573 AZ Practitioner - Nurse Practitioner 4486740164

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN057171AZMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Old Pueblo Healthcare LLC Nurse Practitioner Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349740800000",
    "number": "1295774933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43100",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85733",
            "telephone_number": "520-722-3777",
            "fax_number": "520-296-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5981 E. GRANT RD.",
            "address_2": "STE 155",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "85712",
            "telephone_number": "520-886-5315",
            "fax_number": "520-298-8204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROWN",
        "first_name": "MARY",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "RN057171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "880460",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.