Provider Demographics
NPI:1407249964
Name:MAHON, MARGARET JEAN
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:JEAN
Last Name:MAHON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:JEAN STREET
Other - Last Name:MAHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2449 BOLIER AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3306
Mailing Address - Country:US
Mailing Address - Phone:707-633-6384
Mailing Address - Fax:
Practice Address - Street 1:2449 BOLIER AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3306
Practice Address - Country:US
Practice Address - Phone:707-633-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95002161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95002161OtherFAMILY NURSE PRACTITIONER CERTIFICATE NUMBER