=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194758615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA CRUZ CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2006
-----------------------------------------------------
Last Update Date | 11/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 483 W. SEED FARM RD.
-----------------------------------------------------
City | SACATON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85147-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-528-1200
-----------------------------------------------------
Fax | 602-528-1255
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 38
-----------------------------------------------------
City | SACATON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85147-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-528-1200
-----------------------------------------------------
Fax | 602-528-1255
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | AP5785
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | RN040483
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------