Healthcare Provider Details

I. General information

NPI: 1740642297
Provider Name (Legal Business Name): WILLOW MIDWIFE CENTER FOR BIRTH AND WELLNESS AZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S VINEYARD SUITE 2E
MESA AZ
85210-6889
US

IV. Provider business mailing address

2045 S VINEYARD STE 136
MESA AZ
85210-6891
US

V. Phone/Fax

Practice location:
  • Phone: 630-745-8937
  • Fax:
Mailing address:
  • Phone: 480-565-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANE ORTEGA
Title or Position: MIDWIFE, CO-FOUNDER
Credential: DNP, MSN, CNM
Phone: 480-540-3745