Healthcare Provider Details

I. General information

NPI: 1073244778
Provider Name (Legal Business Name): ARIELLE NISTASHA ERNESTINE BAKHIET CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD STE 155
PHOENIX AZ
85037-0910
US

IV. Provider business mailing address

9305 W THOMAS RD STE 155
PHOENIX AZ
85037-0910
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-1780
  • Fax: 623-936-9116
Mailing address:
  • Phone: 623-936-1780
  • Fax: 623-936-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number276791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: