Provider Demographics
NPI:1669422481
Name:FAHEY, MARY MARGARET (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:FAHEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:380 W VISTA HERMOSA DR
Mailing Address - Street 2:140
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1999
Mailing Address - Country:US
Mailing Address - Phone:520-399-2291
Mailing Address - Fax:520-399-0180
Practice Address - Street 1:380 W VISTA HERMOSA DR
Practice Address - Street 2:140
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1999
Practice Address - Country:US
Practice Address - Phone:520-399-2291
Practice Address - Fax:520-399-0180
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN026544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily