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General NPI Number Information
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NPI Number | 1730778648
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Entity Type | Individual
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Provider Name | EMMA MARIE STEPHENS
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Gender | Female
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 18422 W ROMA AVE
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City | GOODYEAR
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State | AZ
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Zip | 85395-6462
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Country | US
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Telephone | 602-573-9537
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Fax |
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Provider Business Mailing Address
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Address Line | 1345 E MAIN ST
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City | MESA
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State | AZ
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Zip | 85203-8947
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Country | US
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Telephone | 480-404-7158
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 251899
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 251899
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License Number State | AZ
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