Healthcare Provider Details

I. General information

NPI: 1578670121
Provider Name (Legal Business Name): CONNIE ANN GARCIA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6610 W CORDIA LN
PHOENIX AZ
85083-7404
US

IV. Provider business mailing address

6610 W CORDIA LN
PHOENIX AZ
85083-7404
US

V. Phone/Fax

Practice location:
  • Phone: 623-824-3660
  • Fax: 623-572-9405
Mailing address:
  • Phone: 623-824-3660
  • Fax: 623-572-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN092190
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number232
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: