Basic Information
| Provider Information | |||||||||
| NPI: | 1508419433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUND | ||||||||
| FirstName: | MICKI | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9305 W THOMAS RD STE 155 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850370910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232251856 | ||||||||
| 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: | 07/19/2019 | ||||||||
| LastUpdateDate: | 07/19/2019 | ||||||||
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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 | 367A00000X | 229476 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.