Provider Demographics
NPI:1023404266
Name:PIKE, MICHELLE YVONNE (NMD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:YVONNE
Last Name:PIKE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:YVONNE
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:2905 W WARNER RD SUITE 25
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:435-503-0069
Mailing Address - Fax:
Practice Address - Street 1:2905 W WARNER RD SUITE 25
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-752-7600
Practice Address - Fax:480-456-8919
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ15-1486208D00000X
AZ151486175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No175F00000XOther Service ProvidersNaturopath