Provider Demographics
NPI:1679575781
Name:STANTON, PATRICIA L (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:STANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-5119
Mailing Address - Country:US
Mailing Address - Phone:928-669-5550
Mailing Address - Fax:928-669-0061
Practice Address - Street 1:601 W RIVERSIDE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5119
Practice Address - Country:US
Practice Address - Phone:928-669-5550
Practice Address - Fax:928-669-0061
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN033602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ150136Medicaid
AZ150136Medicaid
AZZ134905Medicare PIN