Provider Demographics
NPI:1356038053
Name:MISHAUN PLLC
Entity type:Organization
Organization Name:MISHAUN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISHAUN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:702-339-7688
Mailing Address - Street 1:2865 GRANDHILL RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8512
Mailing Address - Country:US
Mailing Address - Phone:702-339-7688
Mailing Address - Fax:
Practice Address - Street 1:3640 HIGHWAY 95 STE 100
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-4336
Practice Address - Country:US
Practice Address - Phone:702-339-7688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1174897557Medicaid