Provider Demographics
NPI:1467282848
Name:CATCHPOLE, MICHELLE EDIZA
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EDIZA
Last Name:CATCHPOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 W BOSTON WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3620
Mailing Address - Country:US
Mailing Address - Phone:917-833-6112
Mailing Address - Fax:
Practice Address - Street 1:5048 W BOSTON WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3620
Practice Address - Country:US
Practice Address - Phone:917-833-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022941363L00000X
AZ284864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner