Provider Demographics
NPI:1619063740
Name:ALVAREZ, STEPHANIE J (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 MESQUITE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5684
Mailing Address - Country:US
Mailing Address - Phone:928-855-7570
Mailing Address - Fax:928-855-7574
Practice Address - Street 1:1695 MESQUITE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5684
Practice Address - Country:US
Practice Address - Phone:928-855-7570
Practice Address - Fax:928-855-7574
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ544644Medicaid
AZ85808Medicare ID - Type Unspecified