Provider Demographics
NPI:1649203019
Name:MEHLEM, SHEILA MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:MARIE
Last Name:MEHLEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W COUNTRY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5252
Mailing Address - Country:US
Mailing Address - Phone:602-942-0523
Mailing Address - Fax:
Practice Address - Street 1:7650 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1661
Practice Address - Country:US
Practice Address - Phone:623-435-6681
Practice Address - Fax:623-435-6078
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ023650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ504094Medicaid
AZ77311Medicare ID - Type Unspecified