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General NPI Number Information
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NPI Number | 1922399542
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Entity Type | Individual
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Provider Name | STEPHANIE JULIET MAHOOTY N.P.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2011
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 612 W BASELINE RD
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City | MESA
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State | AZ
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Zip | 85210-6041
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Country | US
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Telephone | 480-834-9039
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Fax | 480-964-7802
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Provider Business Mailing Address
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Address Line | 612 W BASELINE RD
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City | MESA
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State | AZ
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Zip | 85210-6041
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Country | US
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Telephone | 480-834-9039
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Fax | 809-647-8024
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R48437
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | CNP02584
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP3997
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License Number State | AZ
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