Healthcare Provider Details

I. General information

NPI: 1922052778
Provider Name (Legal Business Name): MICHELLE SUZANNE DEPIETRO RN,NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD PHOENIX CHILDREN'S HOSPITAL - NICU
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

2329 W SAINT MORITZ LN
PHOENIX AZ
85023-5039
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-5166
  • Fax:
Mailing address:
  • Phone: 602-546-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN057244
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: