Healthcare Provider Details

I. General information

NPI: 1861216632
Provider Name (Legal Business Name): COURTNEY MICHELLE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 E MONTEREY WAY STE 4
SCOTTSDALE AZ
85251-6900
US

IV. Provider business mailing address

7514 E MONTEREY WAY STE 4
SCOTTSDALE AZ
85251-6900
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-5700
  • Fax:
Mailing address:
  • Phone: 480-949-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number315379
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: