Provider Demographics
NPI:1316588049
Name:MAULE, GINGER JENELLE (CNM, RN)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:JENELLE
Last Name:MAULE
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:JENELLE
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3643 E HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3523
Mailing Address - Country:US
Mailing Address - Phone:602-617-6302
Mailing Address - Fax:
Practice Address - Street 1:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - Street 2:HIGHWAY 491 NORTH
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11803367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife