Healthcare Provider Details

I. General information

NPI: 1184102519
Provider Name (Legal Business Name): MICHELLE LYNN GENTSCH RN, AG-ACNP, B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MICHELLE LYNN MAKOWSKI

II. Dates (important events)

Enumeration Date: 07/28/2018
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 S MERCY RD STE 300
GILBERT AZ
85297-0425
US

IV. Provider business mailing address

3420 S MERCY RD STE 300
GILBERT AZ
85297-0425
US

V. Phone/Fax

Practice location:
  • Phone: 480-955-0900
  • Fax: 480-955-0800
Mailing address:
  • Phone: 480-955-0900
  • Fax: 480-955-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN164877
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number218028
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: