Healthcare Provider Details

I. General information

NPI: 1295625374
Provider Name (Legal Business Name): MAKAYLA RUE MARINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 E LINCOLN DR
PHOENIX AZ
85016-2317
US

IV. Provider business mailing address

835 W RIO SALADO PKWY UNIT 3053
TEMPE AZ
85281-3880
US

V. Phone/Fax

Practice location:
  • Phone: 918-350-0148
  • Fax:
Mailing address:
  • Phone: 918-350-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number294114
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number294114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: