Healthcare Provider Details

I. General information

NPI: 1437565876
Provider Name (Legal Business Name): MOMDOC MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 E PECOS RD STE 516
GILBERT AZ
85295-3205
US

IV. Provider business mailing address

2545 W FRYE RD STE 5
CHANDLER AZ
85224-6273
US

V. Phone/Fax

Practice location:
  • Phone: 480-814-1910
  • Fax: 480-821-3610
Mailing address:
  • Phone: 480-821-3600
  • Fax: 480-821-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number8263
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number8263
License Number StateAZ

VIII. Authorized Official

Name: HEATHER HARNER
Title or Position: CREDENTIALING
Credential:
Phone: 480-821-3610