Provider Demographics
NPI:1124411087
Name:RESENDEZ BASSETTI, MALLORIE ESTELLE (CNM)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:ESTELLE
Last Name:RESENDEZ BASSETTI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 E RAY RD UNIT 366
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4518
Mailing Address - Country:US
Mailing Address - Phone:480-818-9530
Mailing Address - Fax:833-963-2174
Practice Address - Street 1:3530 S VAL VISTA DR STE A111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7319
Practice Address - Country:US
Practice Address - Phone:480-818-9530
Practice Address - Fax:833-963-2174
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife