MEDICARE: MS. JEAN STANLEY MSN APRN-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F330925	NY
2	363LF0000X	Family Nurse Practitioner	RN 103594 #702	AZ
3	363LG0600X	Gerontology Nurse Practitioner	F340487	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F330925	OTHER	NY	NY FNP LICENSE
2	RN103594	OTHER	AZ	AZ NURSING LICENSE
3	446220	OTHER	AZ	AHCCCS ID NUMBER
4	F340487	OTHER	NY	NY GNP LICENSE
5	382208	OTHER	NY	NY RN LICENSE
6	702	OTHER	AZ	AZ NP CERTIFICATE

General Provider Information

NPI Number	:	1548251630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN STANLEY MSN APRN-BC

Provider Business Mailing Address
First Line	:	15036 N MAYFLOWER DR
Second Line	:
City	:	FOUNTAIN HILLS
State	:	AZ
Zip	:	85268-2251
Country	:	US
Telephone Number	:	480-836-1809
Fax Number	:	480-836-1814

Provider Business Practice Location Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-621-0596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	03/07/2023

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