Provider Demographics
NPI:1770715070
Name:RAFFERTY, MICHELLE (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W OASIS DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-9513
Mailing Address - Country:US
Mailing Address - Phone:520-940-1119
Mailing Address - Fax:520-744-6697
Practice Address - Street 1:3901 W OASIS DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9513
Practice Address - Country:US
Practice Address - Phone:520-940-1119
Practice Address - Fax:520-744-6697
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN125196163W00000X
AZAP3427363LG0600X, 363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health