Healthcare Provider Details

I. General information

NPI: 1972707255
Provider Name (Legal Business Name): MARLA ELAINE SAMPLE-ORMES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLA ELAINE SAMPLE FARMER ARNP

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 W WANDER RD
NEW RIVER AZ
85087-6903
US

IV. Provider business mailing address

2940 W WANDER RD
NEW RIVER AZ
85087-6903
US

V. Phone/Fax

Practice location:
  • Phone: 623-221-4409
  • Fax:
Mailing address:
  • Phone: 623-465-8647
  • Fax: 623-465-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30002445
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN095303 AP570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: