Healthcare Provider Details

I. General information

NPI: 1740903095
Provider Name (Legal Business Name): STACY MANES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 E THOMAS RD STE 100
SCOTTSDALE AZ
85251-7033
US

IV. Provider business mailing address

25787 W GIBSON LN
BUCKEYE AZ
85326-9172
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-0606
  • Fax:
Mailing address:
  • Phone: 623-202-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number281058
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: