Provider Demographics
NPI:1477872786
Name:PANDE, MICHELLE LEIGH (MICHELLE PANDE NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:PANDE
Suffix:
Gender:F
Credentials:MICHELLE PANDE NP-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MICHELLE PANDE
Mailing Address - Street 1:9250 N 3RD ST
Mailing Address - Street 2:SUITE 4010
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2437
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-399-2002
Practice Address - Fax:480-380-4035
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3613363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0783428OtherTAX-ID