Healthcare Provider Details

I. General information

NPI: 1760653836
Provider Name (Legal Business Name): MICHELLE R. LAMENDOLA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 S MILL AVE STE 212
TEMPE AZ
85281-5664
US

IV. Provider business mailing address

1492 S MILL AVE STE 212
TEMPE AZ
85281-5664
US

V. Phone/Fax

Practice location:
  • Phone: 480-410-4128
  • Fax: 480-410-4130
Mailing address:
  • Phone: 480-410-4128
  • Fax: 480-410-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP7225
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: