Provider Demographics
NPI:1063814879
Name:MUCHA, NANCY (CNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:MUCHA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3327
Mailing Address - Country:US
Mailing Address - Phone:480-219-6631
Mailing Address - Fax:480-247-3251
Practice Address - Street 1:2843 N 89TH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-4278
Practice Address - Country:US
Practice Address - Phone:480-396-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7292207Q00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty