Provider Demographics
NPI:1386670024
Name:MULCAHEY, MARCIA S (NP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:S
Last Name:MULCAHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 12TH PL
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1433
Practice Address - Country:US
Practice Address - Phone:602-851-3030
Practice Address - Fax:877-357-9474
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8044363LA2200X
IN71000902A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279003Medicaid
IN100213290AMedicaid
IN705400CMedicare PIN
P12386Medicare UPIN
IN200896750Medicaid
INP01453886Medicare PIN
INM400064954Medicare PIN
IN267030041Medicare PIN