Individual
STACIE E DEMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259-5404
(480) 301-8000
Mailing address
13400 E SHEA BLVD, SCOTTSDALE, AZ 85259-5404
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2117
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
438558
—
AZ
01
—
86080015085259C045
TRIWEST
AZ
Enumeration date
11/20/2005
Last updated
10/29/2007
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