Healthcare Provider Details

I. General information

NPI: 1245159045
Provider Name (Legal Business Name): CIARA ELY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 N 63RD AVE
GLENDALE AZ
85308-7138
US

IV. Provider business mailing address

5442 W BAJADA RD
PHOENIX AZ
85083-7309
US

V. Phone/Fax

Practice location:
  • Phone: 623-376-4300
  • Fax:
Mailing address:
  • Phone: 602-527-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number218391
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: