Healthcare Provider Details

I. General information

NPI: 1639015407
Provider Name (Legal Business Name): MICHAEL GEORGE MOUSHI FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9165 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4847
US

IV. Provider business mailing address

9165 W THUNDERBIRD RD STE 101
PEORIA AZ
85381-4847
US

V. Phone/Fax

Practice location:
  • Phone: 623-249-2100
  • Fax: 623-476-7305
Mailing address:
  • Phone: 623-249-2100
  • Fax: 623-476-7305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number250862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: