Healthcare Provider Details

I. General information

NPI: 1982087946
Provider Name (Legal Business Name): STEJI KOSHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

IV. Provider business mailing address

1728 E CORTEZ DR
GILBERT AZ
85234-4961
US

V. Phone/Fax

Practice location:
  • Phone: 480-474-5668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP7920
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP7920
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: