Healthcare Provider Details

I. General information

NPI: 1043192206
Provider Name (Legal Business Name): STACY BAUMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACY STUDDARD

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 W CENTERRA DR S
GOODYEAR AZ
85338-2956
US

IV. Provider business mailing address

3993 S 178TH DR
GOODYEAR AZ
85338-8042
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-4800
  • Fax:
Mailing address:
  • Phone: 630-347-1167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296039
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: