Healthcare Provider Details

I. General information

NPI: 1700392495
Provider Name (Legal Business Name): STEPHANIE MEYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 W STATLER BLVD STE 150
SURPRISE AZ
85374-5512
US

IV. Provider business mailing address

6910 W KRISTAL WAY
GLENDALE AZ
85308-5772
US

V. Phone/Fax

Practice location:
  • Phone: 480-556-0446
  • Fax: 480-556-0447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2883
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: