Basic Information
| Provider Information | |||||||||
| NPI: | 1033226519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TASH | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3030 N CENTRAL AVE STE 1001 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024064786 | ||||||||
| FaxNumber: | 9166364358 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W THOMAS RD STE 720&730 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063715 | ||||||||
| FaxNumber: | 6024064011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | RN031500 | AZ | N | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory | 176B00000X | RN031500 | AZ | N | Other Service Providers | Midwife | 367A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | AP6188 | AZ | Y | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | RN031500 | 01 | AZ | RN | OTHER | 1927 | 01 | AZ | CNM | OTHER | MT0012675 | 01 | AZ | DEA | OTHER | 234282 | 05 | AZ | MEDICAID |