Provider Demographics
NPI:1154712826
Name:AVETA MIDWIFERY LLC
Entity type:Organization
Organization Name:AVETA MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:480-216-1837
Mailing Address - Street 1:1020 S ROLES DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8605
Mailing Address - Country:US
Mailing Address - Phone:480-216-1837
Mailing Address - Fax:
Practice Address - Street 1:1020 S ROLES DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-8605
Practice Address - Country:US
Practice Address - Phone:480-216-1837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7625367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty