Basic Information
| Provider Information | |||||||||
| NPI: | 1679575781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STANTON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 W RIVERSIDE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853445119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286695550 | ||||||||
| FaxNumber: | 9286690061 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W RIVERSIDE DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853445119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286695550 | ||||||||
| FaxNumber: | 9286690061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 09/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN033602 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 150136 | 05 | AZ | MEDICAID |