Individual
MICHELLE HUSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4264
(623) 876-8816
(623) 298-0168
Mailing address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4264
(623) 876-8816
(623) 298-0168
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7365
AZ
363AM0700X
Medical Physician Assistant
7365
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504592
—
AZ
01
—
7365
ARIZONA BOARD OF PHYSICIAN ASSISTANTS
AZ
Enumeration date
03/05/2019
Last updated
09/15/2023
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