Healthcare Provider Details

I. General information

NPI: 1548251630
Provider Name (Legal Business Name): JEAN STANLEY MSN APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 N CENTRAL AVE SUITE 800
PHOENIX AZ
85012-2902
US

IV. Provider business mailing address

15036 N MAYFLOWER DR
FOUNTAIN HILLS AZ
85268-2251
US

V. Phone/Fax

Practice location:
  • Phone: 602-621-0596
  • Fax:
Mailing address:
  • Phone: 480-836-1809
  • Fax: 480-836-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330925
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 103594 #702
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberF340487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: