Fardelos, Theresa E

Fardelos, Theresa E is an individual health care provider with primary practice located at 500 W Thomas Rd Suite 730, Phoenix AZ 85013-4224. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Fardelos, Theresa E can be contacted via phone (602) 406-4628.

Contact Information

Primary practice address
500 W Thomas Rd Suite 730 Phoenix AZ 85013-4224
Phone: (602) 406-4628
Fax: (602) 798-9854
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 091351 Arizona

Profile Details

NPI number 1578675047
LBN Legal business name Fardelos, Theresa E
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2006
Last updated Apr 23rd, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578675047 NPPES
Arizona MEDICAID 459124

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