Healthcare Provider Details

I. General information

NPI: 1487517017
Provider Name (Legal Business Name): CARLY FAITH OLIVARES WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16611 S 40TH ST
PHOENIX AZ
85048-0562
US

IV. Provider business mailing address

13834 S 41ST PL
PHOENIX AZ
85044-4662
US

V. Phone/Fax

Practice location:
  • Phone: 480-785-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number230356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: