Healthcare Provider Details

I. General information

NPI: 1801894092
Provider Name (Legal Business Name): INGRID M. GOLD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 W INDIAN SCHOOL RD BUILDING 2 SUITE# 140
PHOENIX AZ
85037-5904
US

IV. Provider business mailing address

10240 W INDIAN SCHOOL RD BUILDING 2 SUITE# 140
PHOENIX AZ
85037-5904
US

V. Phone/Fax

Practice location:
  • Phone: 623-846-7558
  • Fax: 623-846-1674
Mailing address:
  • Phone: 623-846-7558
  • Fax: 623-846-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN092976
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number092976
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN092976
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP0220
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: