Provider Demographics
NPI:1871586834
Name:BRADY, MARY ISABEL (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ISABEL
Last Name:BRADY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:52 E MONTEREY WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2628
Mailing Address - Country:US
Mailing Address - Phone:602-604-9500
Mailing Address - Fax:602-631-9303
Practice Address - Street 1:4350 N 19TH AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015
Practice Address - Country:US
Practice Address - Phone:602-264-9191
Practice Address - Fax:602-532-2973
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ3131363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB1181926OtherDEA