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NPI Code Detail

MEDICARE: DONNA M BARISICH CNM

MEDICARE: DONNA M BARISICH CNM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN169733AZ
2367A00000XAdvanced Practice MidwifeNP4132AZ

General Provider Information

NPI Number : 1174524102
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA M BARISICH CNM
Provider Business Mailing Address
First Line : 3660 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85019-1953
Country : US
Telephone Number : 602-973-3200
Fax Number : 602-973-3200
Provider Business Practice Location Address
First Line : 3660 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85019-1953
Country : US
Telephone Number : 602-973-3200
Fax Number : 602-973-3200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 01/23/2012

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