Individual
GLENN ANDREW MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
8910 VERNON ROAD, LAKE STEVENS, WA 98258
(425) 335-0966
(425) 335-5145
Mailing address
3901 HOYT AVENUE, EVERETT, WA 98201
(425) 339-5462
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
12451
GA
363AM0700X
Medical Physician Assistant
PA60042438
WA
363AM0700X
Medical Physician Assistant
PAC942
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100507753
—
NV
05
—
100507754
—
NV
Enumeration date
02/08/2006
Last updated
09/17/2024
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