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NPI Code Detail

MEDICARE: ELLIE TAN MSN, CNM, WHNP-BC

MEDICARE: ELLIE TAN MSN, CNM, WHNP-BC
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
1363LW0102XWomen's Health Nurse PractitionerAP7917AZ
2367A00000XAdvanced Practice MidwifeAP7917AZ

General Provider Information

NPI Number : 1285017681
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLIE TAN MSN, CNM, WHNP-BC
Provider Business Mailing Address
First Line : 6707 N 19TH AVE STE 222
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1106
Country : US
Telephone Number : 602-283-3668
Fax Number : 877-977-9438
Provider Business Practice Location Address
First Line : 6707 N 19TH AVE STE 222
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-1106
Country : US
Telephone Number : 602-283-3668
Fax Number : 877-977-9438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2015
Last Update Date : 04/13/2022

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