Provider Demographics
NPI:1013492354
Name:GOMEZ, ANNA M (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7705
Mailing Address - Country:US
Mailing Address - Phone:602-256-7766
Mailing Address - Fax:602-265-6644
Practice Address - Street 1:2928 N 18TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7705
Practice Address - Country:US
Practice Address - Phone:602-256-7766
Practice Address - Fax:602-265-6644
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218023367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife