Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP10075 | AZ |
NPI | 1073041331 |
---|---|
Provider Name | Michelle Resendez |
First Address | Gilbert, AZ 85298 |
Second Address | Mesa, AZ 85209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 11/02/2020 |