Provider Demographics
NPI:1396061842
Name:CARDON, MICHELLE L (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:CARDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:77 W FOREST AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1482
Mailing Address - Country:US
Mailing Address - Phone:928-773-2505
Mailing Address - Fax:928-773-2504
Practice Address - Street 1:77 W FOREST AVE STE 117
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1482
Practice Address - Country:US
Practice Address - Phone:928-773-2505
Practice Address - Fax:928-773-2504
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR171675-9367500000X
AZCRNA0684367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered