Provider Demographics
NPI:1598790230
Name:FISHER PINSON, MARY T (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:FISHER PINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 N 85TH WAY STE 113
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4321
Mailing Address - Country:US
Mailing Address - Phone:480-534-8662
Mailing Address - Fax:480-935-0513
Practice Address - Street 1:8035 N 85TH WAY STE 113
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4321
Practice Address - Country:US
Practice Address - Phone:480-534-8662
Practice Address - Fax:480-935-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN070132363LP0808X
AZAP1335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ578685Medicaid
AZZ135588Medicare PIN