Provider Demographics
NPI:1518200641
Name:PICCHIONI, MARY J (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:PICCHIONI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N EL DORADO PL
Mailing Address - Street 2:SUITE I-905
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4637
Mailing Address - Country:US
Mailing Address - Phone:520-954-2551
Mailing Address - Fax:520-344-8871
Practice Address - Street 1:1200 N EL DORADO PL
Practice Address - Street 2:SUITE I-905
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-954-2551
Practice Address - Fax:520-344-8871
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005040133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DN005040OtherDN005040