Healthcare Provider Details

I. General information

NPI: 1245476621
Provider Name (Legal Business Name): STEPHANIE ANNE EASTMAN N.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W LYNWOOD ST
PHOENIX AZ
85003-1204
US

IV. Provider business mailing address

33 W LYNWOOD ST
PHOENIX AZ
85003-1204
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-6252
  • Fax: 602-252-6253
Mailing address:
  • Phone: 602-252-6252
  • Fax: 602-252-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number58
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number01-631
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: