Individual
ELIZABETH MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1055 N 500 W # 205, PROVO, UT 84604-3305
(801) 429-8095
(801) 354-8265
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12474207-1206
UT
Other
Enumeration date
10/21/2021
Last updated
01/31/2022
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