Individual
MARY MATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1066 N POWER RD, STE. 101, MESA, AZ 85205-5709
(480) 353-2200
Mailing address
1440 S VAL VISTA DR, #2093, MESA, AZ 85204-6440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3576
AZ
Other
Enumeration date
12/13/2006
Last updated
07/08/2007
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