Michelle Weissgerber
Individual provider Active NPI Family Nurse Practitioner · Glendale, AZ
NPI 1548784648 · NPPES record last updated May 24, 2018
Key facts
- NPI
- 1548784648
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 5847 (MN)
- Practice address
- 6640 W Maui LN
Glendale, AZ 85306 - Phone
- (906) 748-0567
- NPI assigned
- Jul 31, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180827002935 | MN | Practitioner - Nurse Practitioner | 2163771973 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN177583 | AZ | MD | Registered Nurse |
| 2464024 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matrix Medical Plus | Current |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
121 Washington Ave N
Fl 4
Minneapolis, MN 55401
Phone (404) 992-2702
424 Church St
Ste 2600
Nashville, TN 37219
Phone (480) 450-3721
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5847 | MN | Yes |
| Registered Nurse | 163W00000X | RN177583 | AZ | |
| Registered Nurse | 163W00000X | 2464024 | MN |
Addresses
Primary practice location
6640 W Maui LN
Glendale, AZ 85306
Mailing address
6640 W Maui LN
Glendale, AZ 85306-3164
Other providers in Glendale, AZ
- Timothy Weise
- Tara Weisenburger
- Nicholas Joseph Weisman
- Chanie Weiss
- Laureen Weiss
- Aeshli Laree Weldert
- Emily Welker
- Wellcare, LLC
- Katharina Wells
- Teresa Wells
All providers in Glendale, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.