Provider Demographics
NPI:1114600707
Name:AHERN, MARY MICHAEL (RDN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MICHAEL
Last Name:AHERN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6503 E PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5059
Mailing Address - Country:US
Mailing Address - Phone:480-720-0097
Mailing Address - Fax:
Practice Address - Street 1:6503 E PARADISE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5059
Practice Address - Country:US
Practice Address - Phone:480-720-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86210723133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered