Healthcare Provider Details

I. General information

NPI: 1295354447
Provider Name (Legal Business Name): ERIN MARIANO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36375 N GANTZEL RD STE 103
SAN TAN VALLEY AZ
85140-7334
US

IV. Provider business mailing address

22451 S 201ST ST
QUEEN CREEK AZ
85142-6267
US

V. Phone/Fax

Practice location:
  • Phone: 480-987-5500
  • Fax:
Mailing address:
  • Phone: 480-544-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN156532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: