Basic Information
| Provider Information | |||||||||
| NPI: | 1730252198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAZZONE | ||||||||
| FirstName: | MICHELINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | DNP, RN, CPNP-PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9305 W THOMAS RD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850373328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233883216 | ||||||||
| FaxNumber: | 6233884902 | ||||||||
| Practice Location | |||||||||
| Address1: | 9305 W THOMAS RD | ||||||||
| Address2: | SUITE 125 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850373328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233883216 | ||||||||
| FaxNumber: | 6233884902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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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 | 163W00000X | RN060838 | AZ | N | Nursing Service Providers | Registered Nurse | 363LP0200X | AP6952 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 819276 | 05 | AZ | MEDICAID |