Individual
MS. MITZI D NALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
668 E PENNY LN, SAN TAN VALLEY, AZ 85140-4152
(480) 677-3842
Mailing address
668 E PENNY LN, SAN TAN VALLEY, AZ 85140-4152
(480) 677-3842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2945
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
908238
—
AZ
Enumeration date
04/26/2006
Last updated
06/17/2011
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