Provider Demographics
NPI:1144936550
Name:HUTSELL, ANGALISA MICHELLE NICOLE (ARNP-RNP)
Entity type:Individual
Prefix:
First Name:ANGALISA
Middle Name:MICHELLE NICOLE
Last Name:HUTSELL
Suffix:
Gender:F
Credentials:ARNP-RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8763 E BELL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1318
Mailing Address - Country:US
Mailing Address - Phone:480-927-3800
Mailing Address - Fax:
Practice Address - Street 1:700 N ESTRELLA PKWY STE 235
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9332
Practice Address - Country:US
Practice Address - Phone:480-927-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ286604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily