Healthcare Provider Details

I. General information

NPI: 1427804608
Provider Name (Legal Business Name): SHANNON MAESER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N 43RD AVE STE 510
PHOENIX AZ
85051-5771
US

IV. Provider business mailing address

3251 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1222
US

V. Phone/Fax

Practice location:
  • Phone: 623-207-5465
  • Fax: 623-207-5405
Mailing address:
  • Phone: 928-772-2582
  • Fax: 877-319-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number297067
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: