Healthcare Provider Details

I. General information

NPI: 1306683065
Provider Name (Legal Business Name): MICHELLE REIJONEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 S RURAL RD STE 112
TEMPE AZ
85282-5500
US

IV. Provider business mailing address

3920 S RURAL RD STE 112
TEMPE AZ
85282-5500
US

V. Phone/Fax

Practice location:
  • Phone: 480-674-9220
  • Fax: 480-508-1524
Mailing address:
  • Phone: 480-674-9220
  • Fax: 480-508-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number266435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: