Provider Demographics
NPI:1922052778
Name:DEPIETRO, MICHELLE SUZANNE (RN,NNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:DEPIETRO
Suffix:
Gender:F
Credentials:RN,NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 W SAINT MORITZ LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5039
Mailing Address - Country:US
Mailing Address - Phone:602-546-1454
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:PHOENIX CHILDREN'S HOSPITAL - NICU
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-239-5166
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057244163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN057244OtherNURSING LICENSE