Healthcare Provider Details

I. General information

NPI: 1447629902
Provider Name (Legal Business Name): STEPHANIE NIEPOKOJ- DUNN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N 9TH ST SUITE A
PHOENIX AZ
85006-2522
US

IV. Provider business mailing address

1515 N 9TH ST SUITE A
PHOENIX AZ
85006-2522
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-5545
  • Fax: 602-252-6115
Mailing address:
  • Phone: 602-258-5545
  • Fax: 602-252-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN147387
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8106
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: