Healthcare Provider Details

I. General information

NPI: 1396041463
Provider Name (Legal Business Name): MARA GRONLI EVANS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N ARLINGTON AVE STE 400
RENO NV
89503-4451
US

IV. Provider business mailing address

645 N ARLINGTON AVE STE 400
RENO NV
89503-4451
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-6241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number106
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704358872
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: