Healthcare Provider Details

I. General information

NPI: 1003126244
Provider Name (Legal Business Name): MICHELE A RIEP CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP4619
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: