1477872786 NPI number — MRS. MICHELLE LEIGH PANDE MICHELLE PANDE NP-C

Table of content: MRS. MICHELLE LEIGH PANDE MICHELLE PANDE NP-C (NPI 1477872786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477872786 NPI number — MRS. MICHELLE LEIGH PANDE MICHELLE PANDE NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANDE
Provider First Name:
MICHELLE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MICHELLE PANDE NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOHL
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MICHELLE PANDE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477872786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9250 N 3RD ST
Provider Second Line Business Mailing Address:
SUITE 4010
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85020-2437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-633-3848
Provider Business Mailing Address Fax Number:
602-633-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10238 E HAMPTON AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85209-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-399-2002
Provider Business Practice Location Address Fax Number:
480-380-4035
Provider Enumeration Date:
05/26/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  AP3613 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86-0783428 . This is a "TAX-ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".