Healthcare Provider Details

I. General information

NPI: 1043174410
Provider Name (Legal Business Name): WHOLE MAMA WELLNESS COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8092 N 16TH AVE
PHOENIX AZ
85021-5419
US

IV. Provider business mailing address

8092 N 16TH AVE
PHOENIX AZ
85021-5419
US

V. Phone/Fax

Practice location:
  • Phone: 480-772-3816
  • Fax:
Mailing address:
  • Phone: 480-772-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JADE MARIE PASSAMONTE
Title or Position: OWNER/FOUNDER
Credential: CD
Phone: 480-772-3816