Healthcare Provider Details

I. General information

NPI: 1720359565
Provider Name (Legal Business Name): EMILY ROSE CORAZZA MS, CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ROSE PESHAK

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

4629 E DESERT DR
PHOENIX AZ
85044-5702
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1557
  • Fax:
Mailing address:
  • Phone: 480-516-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP4411
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP4355
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP4411
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: