Individual
MICHELLE JEANNETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7750 E BROADWAY BLVD STE A100, TUCSON, AZ 85710-3901
(520) 327-1529
Mailing address
7750 E BROADWAY BLVD STE A200, TUCSON, AZ 85710-3901
(520) 327-1529
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00036503
WA
2084P0800X
Psychiatry Physician
Primary
22443
AZ
2084P0800X
Psychiatry Physician
MD00036503
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191007
—
AZ
01
—
22443
ARIZONA MEDICAL BOARD
AZ
05
—
8228892
—
WA
Enumeration date
03/03/2006
Last updated
11/29/2023
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