Provider Demographics
NPI:1396896031
Name:MARCANTEL, MARY C (ND)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:MARCANTEL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:MARCANTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:4718 S JALAPA LN
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-1824
Mailing Address - Country:US
Mailing Address - Phone:480-980-8022
Mailing Address - Fax:
Practice Address - Street 1:6589 S KINGS RANCH RD STE 102B
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2933
Practice Address - Country:US
Practice Address - Phone:480-738-1647
Practice Address - Fax:480-779-6317
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04-791175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath