Individual provider Active NPI

Michelle Iliescu, DNP, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Avondale, AZ
National Provider Identifier
1245924653
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
292946 Issued in AZ
Practice address
506 E Western Ave Ste 104
Avondale, AZ 85323-2422
Phone
(602) 230-7373
NPI assigned
Jun 7, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 292946 AZ Primary

Addresses

Primary practice location

506 E Western Ave Ste 104
Avondale, AZ 85323-2422

Mailing address

235 W Western Ave
Avondale, AZ 85323-1848
Phone (623) 244-2960

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230718002093 AZ Practitioner - Nurse Practitioner 0941660294 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Denova Collaborative Health, LLCGroup PAC ID 2466437736, 141 clinicians

Practice addresses (Care Compare)

750 E Thunderbird Rd
1 3
Phoenix, AZ 85022-5306
Phone (602) 230-7373

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
292946AZMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Denova Collaborative Health, LLC CurrentSince Aug 15, 2023 Accepting new patients
Denova Collaborative Health, LLC CurrentSince Aug 15, 2023 Accepting new patients
Denova Collaborative Health, LLC Current Accepting new patients

Locations

235 W Western Ave
Avondale, AZ 85323
Phone (623) 772-5091

506 E Western Ave
Ste 104
Avondale, AZ 85323

2204 S Dobson Rd
Ste 102
Mesa, AZ 85202

750 E Thunderbird Rd
Ste 13
Phoenix, AZ 85022
Phone (602) 682-7455

3101 N Central Ave
Ste 500
Phoenix, AZ 85012

750 E Thunderbird Rd
#13
Phoenix, AZ 85022

3033 N Central Ave
Ste 700
Phoenix, AZ 85012
Phone (602) 281-7289

750 E Thunderbird Rd
Ste 1
Phoenix, AZ 85022
Phone (602) 942-8512

Interoperability endpoints

  • Direct secure messaging: denova.michelleiliescu@141317.advancedmd-direct.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1245924653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 W WESTERN AVE",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853231848",
            "telephone_number": "623-244-2960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 E WESTERN AVE STE 104",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853232422",
            "telephone_number": "602-230-7373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILIESCU",
        "first_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DNP, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-07",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "292946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Avondale, AZ

Sources for this page

Verify at the official NPI Registry.