Provider Demographics
NPI:1245898568
Name:CHACON, MICHELLE L (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CHACON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 W RAWHIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6339
Mailing Address - Country:US
Mailing Address - Phone:480-540-7324
Mailing Address - Fax:
Practice Address - Street 1:3131 W DURANGO ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-6217
Practice Address - Country:US
Practice Address - Phone:602-506-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP225440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily