Individual
THERESA E FARDELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
500 W THOMAS RD, SUITE 730, PHOENIX, AZ 85013-4224
(602) 406-4628
(602) 798-9854
Mailing address
FILE 56765, LOS ANGELES, CA 90074-6765
(602) 406-3860
(602) 406-6132
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
091351
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
459124
—
AZ
Enumeration date
08/31/2006
Last updated
04/23/2012
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