Individual
MISTY MAPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
297 LAKE HAVASU AVE S STE 204, LAKE HAVASU CITY, AZ 86403-6526
(928) 453-1970
Mailing address
4115 VAGABOND DR, LAKE HAVASU CITY, AZ 86406-9230
(928) 680-0149
(928) 680-0149
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP8774
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP8774
AZ
Other
Enumeration date
06/29/2016
Last updated
04/16/2025
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