Provider Demographics
NPI:1457644114
Name:WORSWICK, STACIE JANE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:JANE
Last Name:WORSWICK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3204
Mailing Address - Country:US
Mailing Address - Phone:860-678-3402
Mailing Address - Fax:844-364-3181
Practice Address - Street 1:3815 S VAL VISTA DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7308
Practice Address - Country:US
Practice Address - Phone:480-782-0993
Practice Address - Fax:833-337-0386
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00167067163WM0102X
WAAP 60205110367A00000X
AZAP8923367A00000X
AZRN201352367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn