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General NPI Number Information
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NPI Number | 1336956507
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Entity Type | Individual
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Provider Name | MARY STYREN
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 500 W THOMAS RD STE 800
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City | PHOENIX
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State | AZ
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Zip | 85013-4217
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Country | US
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Telephone | 602-406-1234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33269
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City | PHOENIX
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State | AZ
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Zip | 85067-3269
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Country | US
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Telephone | 602-406-4786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10953
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License Number State | AZ
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