Healthcare Provider Details

I. General information

NPI: 1851182653
Provider Name (Legal Business Name): FATIMA MICHELLE THORNTON HHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FATIMA MICHELLE NEALY

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 S KACHINA DR
TEMPE AZ
85282-7343
US

IV. Provider business mailing address

4819 S KACHINA DR
TEMPE AZ
85282-7343
US

V. Phone/Fax

Practice location:
  • Phone: 480-652-0115
  • Fax:
Mailing address:
  • Phone: 480-652-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: