Basic Information
| Provider Information | |||||||||
| NPI: | 1073244778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKHIET | ||||||||
| FirstName: | ARIELLE | ||||||||
| MiddleName: | NISTASHA ERNESTINE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CNM | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9305 W THOMAS RD STE 155 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850370910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239361780 | ||||||||
| FaxNumber: | 6239369116 | ||||||||
| Practice Location | |||||||||
| Address1: | 9305 W THOMAS RD STE 155 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850370910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239361780 | ||||||||
| FaxNumber: | 6239369116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 276791 | AZ | Y | Other Service Providers | Midwife |
No ID Information.