Healthcare Provider Details

I. General information

NPI: 1457644114
Provider Name (Legal Business Name): STACIE JANE WORSWICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S VAL VISTA DRIVE SUITE 101
GILBERT AZ
85297-7308
US

IV. Provider business mailing address

560 E THOMAS RD
PHOENIX AZ
85012-3204
US

V. Phone/Fax

Practice location:
  • Phone: 480-782-0993
  • Fax: 833-337-0386
Mailing address:
  • Phone: 860-678-3402
  • Fax: 844-364-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00167067
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP 60205110
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP8923
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN201352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: