Provider Demographics
NPI:1417784729
Name:VAN, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:VAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THANHTHUY
Other - Middle Name:
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 N 3RD STREET
Mailing Address - Street 2:HEALTH NORTH BUILDING, 3RD FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4255
Mailing Address - Country:US
Mailing Address - Phone:480-635-6325
Mailing Address - Fax:
Practice Address - Street 1:2875 E GALVESTON ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-4255
Practice Address - Country:US
Practice Address - Phone:480-635-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program