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General NPI Number Information
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NPI Number | 1578224457
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Entity Type | Individual
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Provider Name | AMANDA LORRAINE STOCKWELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 07/27/2023
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Provider Practice Location Address
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Address Line | 4340 E INDIAN SCHOOL RD STE 21-204
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City | PHOENIX
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State | AZ
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Zip | 85018-5391
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Country | US
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Telephone | 315-521-2455
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Fax | 602-926-7251
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Provider Business Mailing Address
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Address Line | 4340 E INDIAN SCHOOL RD STE 21-204
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City | PHOENIX
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State | AZ
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Zip | 85018-5391
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Country | US
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Telephone | 315-521-2455
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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 | F06210238
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License Number State | AZ
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