Provider Demographics
NPI:1376595843
Name:MEHALIK, GEORGETTE (APRN)
Entity Type:Individual
Prefix:MS
First Name:GEORGETTE
Middle Name:
Last Name:MEHALIK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:M
Other - Last Name:MISIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:13395 N MARANA MAIN ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-4111
Practice Address - Fax:520-682-3817
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH034561-23363LP0200X
AZAP6435363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30341776Medicaid
AZ269608Medicaid
VT1012356Medicaid