Provider Demographics
NPI:1356445563
Name:STEGMAN, NICOLE G (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:G
Last Name:STEGMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:G
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2702 NORTH 3RD STREET
Mailing Address - Street 2:SUITE 4020
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4608
Mailing Address - Country:US
Mailing Address - Phone:602-323-3344
Mailing Address - Fax:602-323-3496
Practice Address - Street 1:690 COFCO CENTER COURT
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-6464
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:602-286-0808
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226723207V00000X
AZ30893207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ738685Medicaid
NY02423169Medicaid
AZH81766Medicare UPIN
AZ738685Medicaid
H81766Medicare UPIN
AZZ38685Medicare PIN
AZ72651Medicare PIN