Provider Demographics
NPI:1447429824
Name:LAYSTROM, STEFANIE ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:ANN
Last Name:LAYSTROM
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:6301 S MCCLINTOCK DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3392
Mailing Address - Country:US
Mailing Address - Phone:480-214-2300
Mailing Address - Fax:480-214-2301
Practice Address - Street 1:2550 E GUADALUPE RD
Practice Address - Street 2:STE. 115
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5114
Practice Address - Country:US
Practice Address - Phone:480-632-1544
Practice Address - Fax:480-632-1533
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2013-08-07
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Provider Licenses
StateLicense IDTaxonomies
AZ3808363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical