Provider Demographics
NPI:1316356207
Name:EMBRY WOMENS HEALTH LLC
Entity Type:Organization
Organization Name:EMBRY WOMENS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOELLEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:480-376-2170
Mailing Address - Street 1:2204 S DOBSON ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-376-2170
Mailing Address - Fax:480-699-0056
Practice Address - Street 1:2204 S DOBSON ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-376-2170
Practice Address - Fax:480-699-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP0240363LP2300X, 363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty