=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952964660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTURY HEALTH CARE NP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2019
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12301 W BELL RD STE B106
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-289-7223
-----------------------------------------------------
Fax | 623-289-7829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12301 W BELL RD STE B106
-----------------------------------------------------
City | SURPRISE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85378-9706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-289-7223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE WITZEL
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 623-289-7223
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------