Healthcare Provider Details

I. General information

NPI: 1154232478
Provider Name (Legal Business Name): STEPHANIE MARSHALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25714 N 20TH AVE
PHOENIX AZ
85085-8627
US

IV. Provider business mailing address

25714 N 20TH AVE
PHOENIX AZ
85085-8627
US

V. Phone/Fax

Practice location:
  • Phone: 480-589-7783
  • Fax:
Mailing address:
  • Phone: 480-589-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN165557
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN165557
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: