Healthcare Provider Details

I. General information

NPI: 1366109746
Provider Name (Legal Business Name): MIKAELA ARIEL DEANS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAELA RIGGS

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S IDAHO RD
APACHE JUNCTION AZ
85119-9008
US

IV. Provider business mailing address

10942 E FLORIAN AVE
MESA AZ
85208-7501
US

V. Phone/Fax

Practice location:
  • Phone: 480-444-1160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266818
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: