Basic Information
Provider Information
NPI: 1821288648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MULCAHY
FirstName: AMY
MiddleName: TOWER
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MULCAHY
OtherFirstName: AMY
OtherMiddleName: RENE
OtherNamePrefix: MRS.
OtherNameSuffix:  
OtherCredential: CNP
OtherLastNameType: 1
Mailing Information
Address1: 3333 BURNET AVE
Address2: ML-2008
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136367966
FaxNumber: 5136367967
Practice Location
Address1: 3333 BURNET AVE
Address2: ML-2008
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136367966
FaxNumber: 5136367967
Other Information
ProviderEnumerationDate: 07/27/2007
LastUpdateDate: 01/26/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XCOA.14321-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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