Provider Demographics
NPI:1114917192
Name:NUNN, L STEPHEN (PA)
Entity Type:Individual
Prefix:
First Name:L STEPHEN
Middle Name:
Last Name:NUNN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8412 E SHEA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6664
Mailing Address - Country:US
Mailing Address - Phone:480-874-1515
Mailing Address - Fax:480-991-8395
Practice Address - Street 1:5410 N SCOTTSDALE RD
Practice Address - Street 2:SUITE B 200
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-5927
Practice Address - Country:US
Practice Address - Phone:480-866-3151
Practice Address - Fax:480-991-8395
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ497520Medicaid
AZ497520Medicaid