Provider Demographics
NPI:1679505812
Name:MICHELE M PETERS FNP
Entity Type:Organization
Organization Name:MICHELE M PETERS FNP
Other - Org Name:PRESCOTT NEUROLOGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-300-1388
Mailing Address - Street 1:1000 AINSWORTH DR
Mailing Address - Street 2:STE A220
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1645
Mailing Address - Country:US
Mailing Address - Phone:928-830-1717
Mailing Address - Fax:877-835-3579
Practice Address - Street 1:1000 AINSWORTH DR
Practice Address - Street 2:STE A220
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1645
Practice Address - Country:US
Practice Address - Phone:928-830-1717
Practice Address - Fax:877-835-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
84660Medicare PIN