Provider Demographics
NPI:1710854500
Name:STAPLETON INTEGRATIVE WELLNESS, LLC
Entity type:Organization
Organization Name:STAPLETON INTEGRATIVE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-NP, PMHNP-BC
Authorized Official - Phone:602-562-1992
Mailing Address - Street 1:15411 W WADDELL RD
Mailing Address - Street 2:STE 102 PMB 1213
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5170
Mailing Address - Country:US
Mailing Address - Phone:602-562-1992
Mailing Address - Fax:602-584-4934
Practice Address - Street 1:17751 W VILLA CHULA LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85387-4049
Practice Address - Country:US
Practice Address - Phone:602-562-1992
Practice Address - Fax:602-584-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty