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NPI Code Detail

MEDICARE: MICHELLE ROOS SHREDER RN

MEDICARE: MICHELLE ROOS SHREDER RN
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
1163WC0200XCritical Care Medicine Registered Nurse278477AZ

General Provider Information

NPI Number : 1427992478
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ROOS SHREDER RN
Provider Business Mailing Address
First Line : 7421 E IVYGLEN ST
Second Line :
City : MESA
State : AZ
Zip : 85207-2913
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7421 E IVYGLEN ST
Second Line :
City : MESA
State : AZ
Zip : 85207-2913
Country : US
Telephone Number : 724-591-2313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 04/17/2026

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