Provider Demographics
NPI:1508294711
Name:REKER, MARY (NMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:REKER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 E CATHY DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3635
Mailing Address - Country:US
Mailing Address - Phone:480-570-6084
Mailing Address - Fax:
Practice Address - Street 1:3570 S VAL VISTA DR
Practice Address - Street 2:SUITE 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7326
Practice Address - Country:US
Practice Address - Phone:480-570-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13-1385175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath