Healthcare Provider Details

I. General information

NPI: 1639862360
Provider Name (Legal Business Name): MEGAN RAE ZILLA CNM, APRN, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3726 E CAROB DR
GILBERT AZ
85298-0427
US

IV. Provider business mailing address

3726 E CAROB DR
GILBERT AZ
85298-0427
US

V. Phone/Fax

Practice location:
  • Phone: 602-821-9118
  • Fax:
Mailing address:
  • Phone: 602-821-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number291223
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: