Healthcare Provider Details

I. General information

NPI: 1134243280
Provider Name (Legal Business Name): STACY LADAWN WEGNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 E SHEA BLVD FL 1
SCOTTSDALE AZ
85254-5750
US

IV. Provider business mailing address

9026 E CASITAS DEL RIO DR
SCOTTSDALE AZ
85255-8344
US

V. Phone/Fax

Practice location:
  • Phone: 480-757-9890
  • Fax: 480-467-3542
Mailing address:
  • Phone: 312-550-2558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001529
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001529
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7507
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: