Provider Demographics
NPI:1003979113
Name:MCPHERSON, MARY ANNE (PA C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13044 ADAMS COURT
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241
Mailing Address - Country:US
Mailing Address - Phone:303-452-3623
Mailing Address - Fax:
Practice Address - Street 1:8889 FOX DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80260-8842
Practice Address - Country:US
Practice Address - Phone:303-430-0823
Practice Address - Fax:303-426-9581
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical