Healthcare Provider Details

I. General information

NPI: 1841742442
Provider Name (Legal Business Name): STACY MAAHS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2016
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 W THUNDERBIRD RD # UCB190
GLENDALE AZ
85306-4900
US

IV. Provider business mailing address

20100 N 78TH PL APT 3076
SCOTTSDALE AZ
85255-3842
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-3349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10368
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: