Provider Demographics
NPI:1720359565
Name:CORAZZA, EMILY ROSE (MS, CNM, WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:CORAZZA
Suffix:
Gender:F
Credentials:MS, CNM, WHNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:PESHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4629 E DESERT DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-5702
Mailing Address - Country:US
Mailing Address - Phone:480-516-8286
Mailing Address - Fax:
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4411363LW0102X, 367A00000X
AZAP4355363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ697169Medicaid
AZZ151588Medicare UPIN