Provider Demographics
NPI:1801530175
Name:MACKESY, MARTHA MAYELLA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MAYELLA
Last Name:MACKESY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 N 74TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4323
Mailing Address - Country:US
Mailing Address - Phone:818-523-2491
Mailing Address - Fax:
Practice Address - Street 1:808 N 74TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-4323
Practice Address - Country:US
Practice Address - Phone:818-523-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily