Healthcare Provider Details

I. General information

NPI: 1780672501
Provider Name (Legal Business Name): CAREY MICHELLE LENNON ND, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 W. SEED FARM ROAD
SACATON AZ
85247-2175
US

IV. Provider business mailing address

1222 W GLENMERE DR
CHANDLER AZ
85224-7544
US

V. Phone/Fax

Practice location:
  • Phone: 520-562-5153
  • Fax:
Mailing address:
  • Phone: 480-786-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN106637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: