MEDICARE: ELIZABETH L KIBBLE L.M.

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
1	176B00000X	Midwife	076	AZ

General Provider Information

NPI Number	:	1285038232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH L KIBBLE L.M.

Provider Business Mailing Address
First Line	:	1665 S LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2522
Country	:	US
Telephone Number	:	520-882-8228
Fax Number	:	520-791-4140

Provider Business Practice Location Address
First Line	:	1665 S LA CHOLLA BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-2522
Country	:	US
Telephone Number	:	520-882-8228
Fax Number	:	520-791-4140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	10/20/2014

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