Provider Demographics
NPI:1962408799
Name:STUART-DAVIS, LINDA LEE (DNP, ANP-BC, CRNFA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:STUART-DAVIS
Suffix:
Gender:F
Credentials:DNP, ANP-BC, CRNFA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ANP-BC, CRNFA
Mailing Address - Street 1:6616 E PALO VERDE LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5949
Mailing Address - Country:US
Mailing Address - Phone:480-650-6804
Mailing Address - Fax:480-948-8344
Practice Address - Street 1:10335 N SCOTTSDALE RD STE F
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-1435
Practice Address - Country:US
Practice Address - Phone:480-650-6804
Practice Address - Fax:480-948-8344
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2020-09-18
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CA441888163W00000X
HI41706163W00000X
AZRN037791163W00000X
HIAPRN-1639363LA2200X
AZ259363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2172053OtherAETNA
AZ29P78DAOtherCCS TPA/ BEECH STREET
AZ417619OtherAZ STATE AHCCCS
AZ7100018OtherAETNA
AZ0199585MOtherCIGNA
AZ1Z5355OtherHEALTHNET
AZAZ402269OtherLUTHERAN PPO
AZ0166530OtherBLUE CROSS BLUE SHIELD
AZ172358442720OtherHUMANA
AZ54772OtherMAYO HEALTH PLAN
AZ1061084283OtherHEALTHNET
AZ500013338OtherMEDICARE RAILROAD
AZ500013338OtherMEDICARE RAILROAD
AZZ20975Medicare ID - Type Unspecified