Healthcare Provider Details

I. General information

NPI: 1013806819
Provider Name (Legal Business Name): MICHELLE MIRCI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2025
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 E VIA LINDA
SCOTTSDALE AZ
85258-5314
US

IV. Provider business mailing address

4560 W ECHO LN
GLENDALE AZ
85302-6509
US

V. Phone/Fax

Practice location:
  • Phone: 480-312-6340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN191146
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: