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General NPI Number Information
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NPI Number | 1215891890
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Entity Type | Individual
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Provider Name | STACY DOUD
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Gender |
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 14300 W GRANITE VALLEY DR
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-5783
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Country | US
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Telephone | 623-203-9147
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Fax |
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Provider Business Mailing Address
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Address Line | 15631 W VENTURA ST
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City | SURPRISE
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State | AZ
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Zip | 85379-5630
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 332611
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License Number State | AZ
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