Provider Demographics
NPI:1518429661
Name:CHOLLEY, MARIAH (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:CHOLLEY
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 1:9059 W. LAKE PLEASANT PKWY
Mailing Address - Street 2:STE E-540
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-322-3380
Mailing Address - Fax:623-322-4399
Practice Address - Street 1:9059 W. LAKE PLEASANT PKWY
Practice Address - Street 2:STE E-540
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-322-3380
Practice Address - Fax:623-322-4399
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ320080797OtherSURPRISE PEDIATRICS