Healthcare Provider Details

I. General information

NPI: 1578940631
Provider Name (Legal Business Name): MICHELLE DIANNE HALE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

IV. Provider business mailing address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

V. Phone/Fax

Practice location:
  • Phone: 623-777-4747
  • Fax:
Mailing address:
  • Phone: 623-777-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number261863
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: