Individual
STACEY BETH GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5701 W TALAVI BLVD, SUITE 180, GLENDALE, AZ 85306-1886
(623) 486-8202
(623) 486-2739
Mailing address
4747 N 7TH ST, SUITE 100, PHOENIX, AZ 85014-3653
(602) 279-7655
(602) 264-1806
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
304376
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
400916
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP3709
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP009026
PA
Other
Enumeration date
05/24/2006
Last updated
11/08/2012
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