Provider Demographics
NPI:1104933670
Name:VOGT-ROBERTS, MARLA ANNE (CNM)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:ANNE
Last Name:VOGT-ROBERTS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:STE 720 AND STE 730
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-406-3715
Practice Address - Fax:602-406-4011
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN106344176B00000X
AZAP7046367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7049OtherCNM
AZ479130Medicaid
MI4704123693OtherNURSE MIDWIFE SPECIALTY
MI4704123693OtherRN
AZRN106344OtherRN
AZ7049OtherCNM
AZZ144859Medicare PIN