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General NPI Number Information
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NPI Number | 1285017681
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Entity Type | Individual
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Provider Name | ELLIE TAN MSN, CNM, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/02/2015
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 6707 N 19TH AVE STE 222
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City | PHOENIX
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State | AZ
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Zip | 85015-1106
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Country | US
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Telephone | 602-283-3668
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Fax | 877-977-9438
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Provider Business Mailing Address
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Address Line | 6707 N 19TH AVE STE 222
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City | PHOENIX
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State | AZ
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Zip | 85015-1106
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Country | US
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Telephone | 602-283-3668
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Fax | 877-977-9438
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | AP7917
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP7917
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License Number State | AZ
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