Healthcare Provider Details

I. General information

NPI: 1619374543
Provider Name (Legal Business Name): MICHELLE R NORTH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14122 W MCDOWELL RD STE 203
GOODYEAR AZ
85395-2505
US

IV. Provider business mailing address

14122 W MCDOWELL RD STE 203
GOODYEAR AZ
85395-2505
US

V. Phone/Fax

Practice location:
  • Phone: 623-349-1711
  • Fax: 623-399-1958
Mailing address:
  • Phone: 623-349-1711
  • Fax: 623-399-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number320285
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: