Healthcare Provider Details

I. General information

NPI: 1508414657
Provider Name (Legal Business Name): MICHELLE WOOD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 E ARBOR AVE SUITE 102
MESA AZ
85206
US

IV. Provider business mailing address

121 E BROADWAY RD APT 24
TEMPE AZ
85282-1327
US

V. Phone/Fax

Practice location:
  • Phone: 480-654-2312
  • Fax: 480-830-8506
Mailing address:
  • Phone: 26-501-3551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7569
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7569
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: