Healthcare Provider Details

I. General information

NPI: 1154245967
Provider Name (Legal Business Name): YOLANDA STEPHENSJOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9251 N 173RD LN
WADDELL AZ
85355-7031
US

IV. Provider business mailing address

9251 N 173RD LN
WADDELL AZ
85355-7031
US

V. Phone/Fax

Practice location:
  • Phone: 623-202-4724
  • Fax:
Mailing address:
  • Phone: 623-202-4724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberLPO393111
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: