Provider Demographics
NPI:1154057453
Name:DECAROLIS, ANNA-MARIA (NMD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA-MARIA
Middle Name:
Last Name:DECAROLIS
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14062 N 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4919
Mailing Address - Country:US
Mailing Address - Phone:702-375-7837
Mailing Address - Fax:
Practice Address - Street 1:14062 N 48TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4919
Practice Address - Country:US
Practice Address - Phone:702-375-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22-1716175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath