Provider Demographics
NPI:1770193179
Name:GLOW MIDWIFERY PLLC
Entity Type:Organization
Organization Name:GLOW MIDWIFERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALLORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESENDEZ BASSETTI
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:480-818-9530
Mailing Address - Street 1:3324 E RAY RD UNIT 366
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4518
Mailing Address - Country:US
Mailing Address - Phone:480-818-9530
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 532
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3210
Practice Address - Country:US
Practice Address - Phone:480-818-9530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty