Provider Demographics
NPI:1790112845
Name:MATERO, HANNE MARI (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:HANNE
Middle Name:MARI
Last Name:MATERO
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 W INDIAN SCHOOL RD STE B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3107
Mailing Address - Country:US
Mailing Address - Phone:602-773-5600
Mailing Address - Fax:
Practice Address - Street 1:1108 W INDIAN SCHOOL RD STE B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3107
Practice Address - Country:US
Practice Address - Phone:602-773-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5550363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ161839Medicare PIN