Provider Demographics
NPI:1235861535
Name:MACRI, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MACRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 N 9TH AVE APT E12
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-0623
Mailing Address - Country:US
Mailing Address - Phone:480-492-9532
Mailing Address - Fax:
Practice Address - Street 1:9802 N 9TH AVE APT E12
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-0623
Practice Address - Country:US
Practice Address - Phone:480-492-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23387169172A00000X
AZD06613295172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver