Provider Demographics
NPI:1003100074
Name:MULICK, LORI H (NP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:H
Last Name:MULICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 E HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2919
Mailing Address - Country:US
Mailing Address - Phone:520-721-8605
Mailing Address - Fax:
Practice Address - Street 1:6565 E. CARONDELET
Practice Address - Street 2:STE. 300
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-323-0333
Practice Address - Fax:520-323-5036
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN085419163W00000X
AZAP7256363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ138059Medicaid