Provider Demographics
NPI:1144550120
Name:MACON, SANDRA J (CNM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:MACON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:839 W CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2819
Mailing Address - Country:US
Mailing Address - Phone:520-792-9890
Mailing Address - Fax:520-884-9287
Practice Address - Street 1:2595 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6104
Practice Address - Country:US
Practice Address - Phone:520-795-9912
Practice Address - Fax:520-795-3394
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001159508176B00000X
AZAP3538176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife