Provider Demographics
NPI:1043039027
Name:STAPLETON, MARISA (PMHNP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17751 W VILLA CHULA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-4049
Mailing Address - Country:US
Mailing Address - Phone:909-938-9527
Mailing Address - Fax:
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:909-938-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ290738363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health