Provider Demographics
NPI:1417429796
Name:DUFFY, STEPHANIE RAE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3333 E CAMELBACK RD STE 180
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2396
Mailing Address - Country:US
Mailing Address - Phone:602-224-3315
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:6622 N 91ST AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85305-2569
Practice Address - Country:US
Practice Address - Phone:623-547-4668
Practice Address - Fax:623-535-7869
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2022-12-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209018586163WN0300X
AZ266165363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WN0300XNursing Service ProvidersRegistered NurseNephrology