Provider Demographics
NPI:1740268028
Name:MCGLASSON, MARY ANASTASIA (ARNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANASTASIA
Last Name:MCGLASSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 E SHEA BLVD UNIT 1054
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4635
Mailing Address - Country:US
Mailing Address - Phone:480-390-9377
Mailing Address - Fax:
Practice Address - Street 1:5122 E SHEA BLVD UNIT 1054
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4635
Practice Address - Country:US
Practice Address - Phone:480-390-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007062363LF0000X
AZAP2940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8858271Medicare UPIN
AZZ121011Medicare UPIN