Provider Demographics
NPI:1891294914
Name:WEARING, MICHELLE SUE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUE
Last Name:WEARING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:951-765-3075
Practice Address - Street 1:1284 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3206
Practice Address - Country:US
Practice Address - Phone:520-723-9131
Practice Address - Fax:520-723-7974
Is Sole Proprietor?:No
Enumeration Date:2018-02-04
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF01181392363LF0000X
AZAP263392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA677424OtherBOARD OF REGISTERED NURSING
CAF01181392OtherAANP