Provider Demographics
NPI:1982388740
Name:MABRY, SIERRA-AMBER GWYNETH
Entity Type:Individual
Prefix:MRS
First Name:SIERRA-AMBER
Middle Name:GWYNETH
Last Name:MABRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIERRA-AMBER
Other - Middle Name:GWYNETH
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1576 PRESCOTT VIEW PL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1548
Mailing Address - Country:US
Mailing Address - Phone:928-308-2681
Mailing Address - Fax:
Practice Address - Street 1:1576 PRESCOTT VIEW PL
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1548
Practice Address - Country:US
Practice Address - Phone:928-308-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-167072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology