Provider Demographics
NPI:1730935024
Name:PATCH, MICHELLE ROSE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROSE
Last Name:PATCH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17242 S HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-8501
Mailing Address - Country:US
Mailing Address - Phone:520-796-3858
Mailing Address - Fax:520-796-3884
Practice Address - Street 1:17242 S HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8501
Practice Address - Country:US
Practice Address - Phone:520-796-3858
Practice Address - Fax:520-796-3884
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN133938163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)