Basic Information
| Provider Information | |||||||||
| NPI: | 1154712826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVETA MIDWIFERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 S ROLES DR | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852968605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802161837 | ||||||||
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| Address1: | 1020 S ROLES DR | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852968605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802161837 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2015 | ||||||||
| LastUpdateDate: | 02/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | FLAKE | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CERTIFIED NURSE MIDWIFE | ||||||||
| AuthorizedOfficialTelephone: | 4802161837 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CNM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | AP7625 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.