Provider Demographics
NPI:1447271564
Name:STUCKY-HEIL, MARY JO (APRN)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:STUCKY-HEIL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY JO
Other - Middle Name:
Other - Last Name:SENTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6116 E ARBOR AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6103
Mailing Address - Country:US
Mailing Address - Phone:480-641-5400
Mailing Address - Fax:480-218-4353
Practice Address - Street 1:6116 E ARBOR AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6107
Practice Address - Country:US
Practice Address - Phone:480-641-5400
Practice Address - Fax:480-218-4353
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN096578363LA2200X
AZAP2518363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ136797Medicaid
111608Medicare PIN
AZ136797Medicaid