Individual
DENISE RENEE STAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2010 HUNT RANCH RD, TAYLOR, AZ 85939
(928) 243-2030
Mailing address
PO BOX 561, TAYLOR, AZ 85939-0561
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
12354
AZ
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12354
FOSTER CARE LICENSE
AZ
Enumeration date
02/28/2013
Last updated
02/28/2013
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