Healthcare Provider Details

I. General information

NPI: 1225151855
Provider Name (Legal Business Name): TANETTE STITES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S MOUNTAIN AVE
SPRINGERVILLE AZ
85938-5104
US

IV. Provider business mailing address

76 E 2ND AVE
EAGAR AZ
85925-9400
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-4368
  • Fax:
Mailing address:
  • Phone: 928-333-4368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222844
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: