Healthcare Provider Details

I. General information

NPI: 1598971210
Provider Name (Legal Business Name): MICHELLE L CEDERLIND NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY CEDERLIND NNP

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE SUITE 375
PHOENIX AZ
85013-3498
US

IV. Provider business mailing address

300 W CLARENDON AVE SUITE 375
PHOENIX AZ
85013-3498
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-4161
  • Fax: 602-266-3481
Mailing address:
  • Phone: 602-277-4161
  • Fax: 602-266-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number136199
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP3381
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: