Provider Demographics
NPI:1942440334
Name:MATHER, TREANNA LYNNE (PA)
Entity Type:Individual
Prefix:
First Name:TREANNA
Middle Name:LYNNE
Last Name:MATHER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:280 S MAIN ST
Mailing Address - Street 2:200
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3852
Mailing Address - Country:US
Mailing Address - Phone:714-634-4567
Mailing Address - Fax:714-634-4569
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:200
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3852
Practice Address - Country:US
Practice Address - Phone:714-634-4567
Practice Address - Fax:714-634-4569
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20026363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical