Healthcare Provider Details

I. General information

NPI: 1902060080
Provider Name (Legal Business Name): LYNN LOUISE MAUPIN PMHNP-BC, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 100
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

PO BOX 7294
GOODYEAR AZ
85338-0639
US

V. Phone/Fax

Practice location:
  • Phone: 602-704-2345
  • Fax: 602-704-2399
Mailing address:
  • Phone: 623-760-7660
  • Fax: 567-243-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP3084
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4302
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP3084
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4302
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP3084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: