Healthcare Provider Details

I. General information

NPI: 1710492582
Provider Name (Legal Business Name): MICHELE RENEE MORITZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE RENEE REDLER

II. Dates (important events)

Enumeration Date: 12/03/2017
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 N 43RD AVE STE 3
GLENDALE AZ
85302-2044
US

IV. Provider business mailing address

10240 N 43RD AVE STE 3
GLENDALE AZ
85302-2044
US

V. Phone/Fax

Practice location:
  • Phone: 480-931-3156
  • Fax: 480-776-0025
Mailing address:
  • Phone: 480-931-3156
  • Fax: 480-776-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340621
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: