Healthcare Provider Details

I. General information

NPI: 1710546239
Provider Name (Legal Business Name): ABIGAIL STUTZ NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E MISSOURI AVE
PHOENIX AZ
85012-1369
US

IV. Provider business mailing address

645 E MISSOURI AVE
PHOENIX AZ
85012-1369
US

V. Phone/Fax

Practice location:
  • Phone: 602-476-8962
  • Fax: 954-618-4766
Mailing address:
  • Phone: 602-476-8962
  • Fax: 954-618-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number175404
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number231906
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: