Healthcare Provider Details

I. General information

NPI: 1760844989
Provider Name (Legal Business Name): MICHELLE WHITT WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 S MERCY RD STE 207
GILBERT AZ
85297-7604
US

IV. Provider business mailing address

3815 SOUTH VAL VISTA DRIVE
GILBERT AZ
85297
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-5900
  • Fax: 480-855-9171
Mailing address:
  • Phone: 480-782-0993
  • Fax: 855-329-8939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP8466
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: