Healthcare Provider Details

I. General information

NPI: 1558339259
Provider Name (Legal Business Name): MICHELE J INGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 N 4TH ST SUITE 2
FLAGSTAFF AZ
86004-1816
US

IV. Provider business mailing address

PO BOX 3630
FLAGSTAFF AZ
86003-3630
US

V. Phone/Fax

Practice location:
  • Phone: 928-213-6100
  • Fax:
Mailing address:
  • Phone: 928-213-6100
  • Fax: 928-774-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP1160
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN090822
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: