Provider Demographics
NPI:1497065486
Name:MOHLIE, HUGHES (ANP)
Entity Type:Individual
Prefix:
First Name:HUGHES
Middle Name:
Last Name:MOHLIE
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 N 19TH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7044
Mailing Address - Country:US
Mailing Address - Phone:602-923-0436
Mailing Address - Fax:480-566-0247
Practice Address - Street 1:7828 N 19TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7044
Practice Address - Country:US
Practice Address - Phone:602-666-1667
Practice Address - Fax:480-566-0247
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5113363LP0808X
AZRN203379363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ895664Medicaid