Healthcare Provider Details

I. General information

NPI: 1992045785
Provider Name (Legal Business Name): STEPHANIE LATIMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 E OAK ST
SCOTTSDALE AZ
85257
US

IV. Provider business mailing address

3811 N 44TH ST
PHOENIX AZ
85018-5420
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-3611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN175135
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11546
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: