MEDICARE: MARIAH THERESE MCCREADY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215506324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH THERESE MCCREADY

Provider Business Mailing Address
First Line	:	5246 MALLARD ESTATES RD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-9524
Country	:	US
Telephone Number	:	530-588-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	5246 MALLARD ESTATES RD
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95973-9524
Country	:	US
Telephone Number	:	530-588-4490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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