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NPI Code Detail

MEDICARE: MICHELLE VIDAURE FNP

MEDICARE: MICHELLE VIDAURE FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerTAP7581AZ
2363LF0000XFamily Nurse PractitionerAP7581AZ

General Provider Information

NPI Number : 1114312006
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE VIDAURE FNP
Provider Business Mailing Address
First Line : 4742 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-5440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4742 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85018-5440
Country : US
Telephone Number : 602-840-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2015
Last Update Date : 03/28/2022

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Directions to “ MICHELLE VIDAURE FNP” Practice Location

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