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Individual

EMMA MARIE STEPHENS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
18422 W ROMA AVE, GOODYEAR, AZ 85395-6462
(602) 573-9537
Mailing address
1345 E MAIN ST, MESA, AZ 85203-8947
(480) 404-7158

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
251899
AZ
363LF0000X
Family Nurse Practitioner
Primary
251899
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
251899
AZ
05
F11200843
AZ
Enumeration date
01/14/2021
Last updated
01/14/2021
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