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General NPI Number Information
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NPI Number | 1740903095
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Entity Type | Individual
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Provider Name | STACY MANES
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 6380 E THOMAS RD STE 100
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7033
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Country | US
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Telephone | 480-607-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 25787 W GIBSON LN
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City | BUCKEYE
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State | AZ
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Zip | 85326-9172
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Country | US
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Telephone | 623-202-4606
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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 | 281058
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License Number State | AZ
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