Provider Demographics
NPI:1215506324
Name:MCCREADY, MARIAH THERESE
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:THERESE
Last Name:MCCREADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 MALLARD ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9524
Mailing Address - Country:US
Mailing Address - Phone:530-588-4490
Mailing Address - Fax:
Practice Address - Street 1:5246 MALLARD ESTATES RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9524
Practice Address - Country:US
Practice Address - Phone:530-588-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program