Basic Information
| Provider Information | |||||||||
| NPI: | 1316356207 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBRY WOMENS HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2204 S DOBSON ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803762170 | ||||||||
| FaxNumber: | 4806990056 | ||||||||
| Practice Location | |||||||||
| Address1: | 2204 S DOBSON ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803762170 | ||||||||
| FaxNumber: | 4806990056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2014 | ||||||||
| LastUpdateDate: | 12/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | EMBRY | ||||||||
| AuthorizedOfficialFirstName: | JOELLEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4803762170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | WHNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP0240 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LX0001X | AP0240 | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LW0102X | AP0240 | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.