Healthcare Provider Details

I. General information

NPI: 1952985111
Provider Name (Legal Business Name): MICHELLE LYNN ESCALANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 S DODGE BLVD STE 10
TUCSON AZ
85713-5479
US

IV. Provider business mailing address

3250 S DODGE BLVD STE 10
TUCSON AZ
85713-5479
US

V. Phone/Fax

Practice location:
  • Phone: 520-269-5510
  • Fax:
Mailing address:
  • Phone: 520-269-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: