Individual
TERESA WILLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM179
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNM179
LICENSE
NC
Enumeration date
01/16/2007
Last updated
09/22/2011
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