Healthcare Provider Details

I. General information

NPI: 1679686034
Provider Name (Legal Business Name): ROBERTA LYNN WARD CNM, FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10005 E OSBORN RD
SCOTTSDALE AZ
85256-4019
US

IV. Provider business mailing address

PO BOX 31001-0698
PASADENA CA
91110-0698
US

V. Phone/Fax

Practice location:
  • Phone: 480-362-7400
  • Fax: 480-362-5950
Mailing address:
  • Phone: 602-263-1200
  • Fax: 602-200-5383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number887
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5200493-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8128
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number5200493-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: