Healthcare Provider Details

I. General information

NPI: 1891294914
Provider Name (Legal Business Name): MICHELLE SUE WEARING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E COTTONWOOD LN
CASA GRANDE AZ
85122-2511
US

IV. Provider business mailing address

PO BOX 96770
PHOENIX AZ
85072-6770
US

V. Phone/Fax

Practice location:
  • Phone: 520-252-4450
  • Fax: 888-517-5468
Mailing address:
  • Phone: 480-660-5913
  • Fax: 844-325-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008778
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number263392
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number677424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: