Healthcare Provider Details

I. General information

NPI: 1508479908
Provider Name (Legal Business Name): BROOKLYN FEUSTEL ELKAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W FRYE RD STE 9
CHANDLER AZ
85224-6277
US

IV. Provider business mailing address

PO BOX 6730
CHANDLER AZ
85246-6730
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-3600
  • Fax: 480-857-2667
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-857-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number2467725
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: