Healthcare Provider Details

I. General information

NPI: 1649305327
Provider Name (Legal Business Name): MICHELLE R MCFALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

12033 AGENCY RD
PARKER AZ
85344-7718
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2137
  • Fax: 928-669-3322
Mailing address:
  • Phone: 928-669-2137
  • Fax: 928-669-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number45048
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: