Healthcare Provider Details

I. General information

NPI: 1942989686
Provider Name (Legal Business Name): MARGARET MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HARPIN DR
EDWARDSVILLE IL
62026-0001
US

IV. Provider business mailing address

4464 MCPHERSON AVE # 3D
SAINT LOUIS MO
63108-2504
US

V. Phone/Fax

Practice location:
  • Phone: 618-650-5688
  • Fax:
Mailing address:
  • Phone: 636-866-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: