Provider Demographics
NPI:1174247787
Name:TRERISE, MARIAH L (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:L
Last Name:TRERISE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14044 W CAMELBACK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-9426
Mailing Address - Country:US
Mailing Address - Phone:623-935-9600
Mailing Address - Fax:623-935-9600
Practice Address - Street 1:14044 W CAMELBACK RD STE 204
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-9426
Practice Address - Country:US
Practice Address - Phone:623-935-9600
Practice Address - Fax:623-935-9600
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant