Healthcare Provider Details

I. General information

NPI: 1730252198
Provider Name (Legal Business Name): MICHELINA STAZZONE DNP, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 W THOMAS RD SUITE 125
PHOENIX AZ
85037-3328
US

IV. Provider business mailing address

9305 W THOMAS RD SUITE 125
PHOENIX AZ
85037-3328
US

V. Phone/Fax

Practice location:
  • Phone: 623-388-3216
  • Fax: 623-388-4902
Mailing address:
  • Phone: 623-388-3216
  • Fax: 623-388-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN060838
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP6952
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: