Healthcare Provider Details

I. General information

NPI: 1710592530
Provider Name (Legal Business Name): MILDRED DENISE KIAWOIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18275 N 59TH AVE STE 126
GLENDALE AZ
85308-1252
US

IV. Provider business mailing address

PO BOX 96770
PHOENIX AZ
85072-6770
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-6181
  • Fax: 877-349-6973
Mailing address:
  • Phone: 480-660-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8864
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number267064
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2149914
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: