Provider Demographics
NPI:1508836479
Name:DIRKS, CECILIA (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:DIRKS
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85702-1231
Mailing Address - Country:US
Mailing Address - Phone:520-795-9912
Mailing Address - Fax:520-795-9934
Practice Address - Street 1:5979 E GRANT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2367
Practice Address - Country:US
Practice Address - Phone:520-795-9912
Practice Address - Fax:520-795-9934
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071765367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ325220Medicaid
AZ325220Medicaid