Provider Demographics
NPI:1548251630
Name:STANLEY, JEAN (MSN APRN-BC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MSN APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15036 N MAYFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2251
Mailing Address - Country:US
Mailing Address - Phone:480-836-1809
Mailing Address - Fax:480-836-1814
Practice Address - Street 1:3003 N CENTRAL AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2902
Practice Address - Country:US
Practice Address - Phone:602-621-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330925363LF0000X
AZRN 103594 #702363LF0000X
NYF340487363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF330925OtherNY FNP LICENSE
AZRN103594OtherAZ NURSING LICENSE
AZ446220OtherAHCCCS ID NUMBER
NYF340487OtherNY GNP LICENSE
NY382208OtherNY RN LICENSE
AZ702OtherAZ NP CERTIFICATE
AZ702OtherAZ NP CERTIFICATE
AZ446220OtherAHCCCS ID NUMBER