Individual
FLORA ISSANDA STOWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1855 S COUNTRY CLUB DR STE 111-130, MESA, AZ 85210-6037
(480) 840-4777
Mailing address
PO BOX 687, LAVEEN, AZ 85339-0687
(480) 840-4777
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP11721
AZ
363LF0000X
Family Nurse Practitioner
AP11721
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP11721
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1700274321
—
AZ
01
—
47-1340390
IRS
AZ
Enumeration date
01/05/2015
Last updated
10/05/2023
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