Provider Demographics
NPI:1629546601
Name:MERCHANT, FABIOLA (CNM, ANP)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:CNM, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S CANDY LN STE 6AB
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4120
Mailing Address - Country:US
Mailing Address - Phone:928-634-0391
Mailing Address - Fax:
Practice Address - Street 1:203 S CANDY LN STE 6AB
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4120
Practice Address - Country:US
Practice Address - Phone:928-634-0391
Practice Address - Fax:928-634-6145
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218773207VX0000X, 363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218773OtherLICENSE