Provider Demographics
NPI:1659073534
Name:FIALA, LORA ELIZABETH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:ELIZABETH
Last Name:FIALA
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 S BRIGHTON CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4980
Mailing Address - Country:US
Mailing Address - Phone:480-620-3889
Mailing Address - Fax:
Practice Address - Street 1:2048 S BRIGHTON CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-4980
Practice Address - Country:US
Practice Address - Phone:480-620-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM268176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife