| Provider / Organization | NPI | Date Certified |
|---|---|---|
| MARY ELIZABETH BASTIAN | 1396351805 | 2020-09-20 |
Mary Elizabeth Bastian is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1396351805. Registration indicates Mary Elizabeth Bastian is a provider of services with a specialization in Respiratory, Developmental, Rehabilitative and Restorative Service Providers, Specialist/Technologist (Specialist/Technologist: Athletic Trainer, ) (All Other Specialties & Provider Types, ) (Specialist/Technologist Athletic Trainer, Respiratory, Developmental, Rehabilitative and Restorative Service Providers) (Specialist/Technologist, ) (Student, Health Care, Student in an Organized Health Care Education/Training Program) (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)
| Entity Type | Individual |
| Provider Name | Mary Elizabeth Bastian |
| Practice Office Address | 1730 S MILL AVE TEMPE, AZ US |
| Practice Office Telephone | 4809671661 |
| Mailing Address | 4950 E VAN BUREN ST APT 372 PHOENIX, AZ 850087054 US |
| Business Telephone | 5857430508 |
| Code | Practice | License No State |
|---|---|---|
| 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Specialist/Technologist: Athletic Trainer All Other Specialties & Provider Types Specialist/Technologist Athletic Trainer Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist | |
| 390200000X PRIMARY | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care |