Healthcare Provider Details

I. General information

NPI: 1568840031
Provider Name (Legal Business Name): STEPHANIE COTTRELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 08/15/2021
Certification Date: 08/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E MORRIS DR
PHOENIX AZ
85012-2323
US

IV. Provider business mailing address

202 E MORRIS DR
PHOENIX AZ
85012-2323
US

V. Phone/Fax

Practice location:
  • Phone: 602-314-7755
  • Fax: 602-314-7756
Mailing address:
  • Phone: 602-314-7755
  • Fax: 602-314-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number261258
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN183961
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: