Provider Demographics
NPI:1174774400
Name:STUTZ, ERIN E (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:E
Last Name:STUTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5777 E MAYO BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-342-1387
Mailing Address - Fax:480-342-1388
Practice Address - Street 1:5777 E MAYO BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-4502
Practice Address - Country:US
Practice Address - Phone:480-342-1387
Practice Address - Fax:480-342-1387
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19629363AM0700X
AZ4273363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00882972OtherRAILROAD MEDICARE
AZ373973Medicaid
AZP00882972OtherRAILROAD MEDICARE