Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1114526159 |
---|---|
Provider Name | Shirley (duffy) Mxmahon |
First Address | Mesa, AZ 85206-4630 |
Second Address | Mesa, AZ 85206-4630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |