Healthcare Provider Details

I. General information

NPI: 1538630579
Provider Name (Legal Business Name): MICHELLE ASHLEY EDWARDS PETERSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10210 N 92ND ST STE 300
SCOTTSDALE AZ
85258-4525
US

IV. Provider business mailing address

2761 W KENT DR
CHANDLER AZ
85224-3904
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220223
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number220223
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number220223
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: