Healthcare Provider Details

I. General information

NPI: 1760006415
Provider Name (Legal Business Name): STEPHANIE ANN RIDEAUX DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 E ROOSEVELT ST
PHOENIX AZ
85008-4948
US

IV. Provider business mailing address

4824 E BASELINE RD STE 129
MESA AZ
85206-4679
US

V. Phone/Fax

Practice location:
  • Phone: 833-855-9973
  • Fax: 602-655-9135
Mailing address:
  • Phone: 480-644-1001
  • Fax: 480-644-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number241579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: