Provider Demographics
NPI:1104981752
Name:MAHONY, EILEEN MARY (FNP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:MAHONY
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 1:140 W SPEEDWAY BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-7687
Mailing Address - Country:US
Mailing Address - Phone:520-628-7871
Mailing Address - Fax:520-205-8461
Practice Address - Street 1:140 W SPEEDWAY
Practice Address - Street 2:SUITE 100 ST ELIZABETH OF HUNGARY CLINIC
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-7698
Practice Address - Country:US
Practice Address - Phone:520-628-7871
Practice Address - Fax:520-205-8461
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN056972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ447624OtherPIMA HEALTH SYSTEMS
AZ447624Medicaid
AZ447624001OtherMERCY CARE PLAN
AZ447624001OtherMERCY CARE PLAN
Q53894Medicare UPIN