Individual
MAKENNA LINDA HANCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 E MAIN ST, MESA, AZ 85201-7409
(602) 888-5500
Mailing address
99 W PALOMINO DR APT 156, CHANDLER, AZ 85225-7711
(605) 680-4975
Taxonomy
Speciality
Code
Description
License number
State
207PS0010X
Sports Medicine (Emergency Medicine) Physician
Primary
009101
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009101
LICENSURE
AZ
01
—
2000027411
BOC CERTIFICATION
—
Enumeration date
12/16/2022
Last updated
12/16/2022
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