Healthcare Provider Details

I. General information

NPI: 1437863172
Provider Name (Legal Business Name): GENESSIS LIZETH CARDENAS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 N CAMINO MERCADO STE 8
CASA GRANDE AZ
85122-5757
US

IV. Provider business mailing address

PO BOX 10097
CASA GRANDE AZ
85130-0020
US

V. Phone/Fax

Practice location:
  • Phone: 520-381-0380
  • Fax: 520-836-1826
Mailing address:
  • Phone: 520-836-3446
  • Fax: 520-836-8807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number331297
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number895877
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN68182
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: