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General NPI Number Information
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NPI Number | 1114324241
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Entity Type | Individual
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Provider Name | AMY GRACE DUFOUR SMITH LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 301 E BETHANY HOME RD C-298
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City | PHOENIX
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State | AZ
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Zip | 85012-1263
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Country | US
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Telephone | 602-405-3744
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Fax |
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Provider Business Mailing Address
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Address Line | 4210 N 33RD PL
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City | PHOENIX
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State | AZ
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Zip | 85018-4730
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Country | US
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Telephone | 602-405-3744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | LM189
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License Number State | AZ
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