Provider Demographics
NPI:1669889473
Name:DESERT BLOSSOM MIDWIFERY LLC
Entity type:Organization
Organization Name:DESERT BLOSSOM MIDWIFERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:520-335-1128
Mailing Address - Street 1:4810 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2440
Mailing Address - Country:US
Mailing Address - Phone:520-335-1128
Mailing Address - Fax:520-335-1132
Practice Address - Street 1:4810 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2440
Practice Address - Country:US
Practice Address - Phone:520-335-1128
Practice Address - Fax:520-335-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-14
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty