MISTY MAPLE (NPI# 1891146957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891146957 |
| Entity Type | Individual |
| Full Name | MISTY MAPLE |
| Credential | FNP-C |
| Practice Address |
101 Civic Center Ln Lake Havasu City AZ 86403-5607 |
| Mailing Address |
4115 Vagabond Dr Lake Havasu City AZ 86406-9230 |
| Practice Telephone | 9284861946 |
| Mailing Telephone | 9286800149 |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2016-06-29 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
AP8774 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
101 CIVIC CENTER LN |
| City | LAKE HAVASU CITY |
| State | AZ |
| Zip Code | 86403-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639176233 | Pamela B. Reband | Anesthesiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2005-06-28 |
| 1659995652 | Alana Stern | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2020-06-04 |
| 1245702927 | Michael Barber | Registered Nurse | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2018-12-19 |
| 1891276630 | Brian Andrew | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2018-08-28 |
| 1497264873 | Pinnacle Radiology Services | Radiology | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-28 |
| 1821516287 | Jaime Wasik | Nurse Practitioner | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2017-09-06 |
| 1144776055 | Paul Queior | Physician Assistant | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2016-08-30 |
| 1316319460 | Sarah Fraser | Specialist/Technologist, Other | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2015-10-28 |
| 1780067280 | Samer Asem Haddad | Internal Medicine | 101 Civic Center Ln, Lake Havasu City, AZ 86403 | 2015-07-01 |
| 1083007942 | Sarah Eller | Registered Nurse | 101 Civic Center Ln, Lake Havasu City, AZ 86403-5607 | 2015-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104479039 | Liska's Apothecary Shop, Inc. | Assisted Living Facility | 1840 Mesquite Ave., Ste. E, Lake Havasu City, AZ 86403 | 2019-07-19 |
| 1275033227 | Ayad Costy | Pharmacist | 75 North Lake Havasu City, Lake Havasu City, AZ 86403 | 2018-02-16 |
| 1942727250 | Ideal Health Care, L.L.C. | Prosthetic/Orthotic Supplier | 1675 Mesquite Ave Ste A, Lake Havasu City, AZ 86403 | 2017-08-28 |
| 1063965036 | Cerner Health Connections, Inc | Clinic/Center | 89 Civic Center Blvd, Lake Havasu City, AZ 86403 | 2016-07-26 |
| 1447643358 | Lundin Dental PC | Durable Medical Equipment & Medical Supplies | 1741 Mesquite Avenue Ste B 100, Lake Havasu City, AZ 86403 | 2015-03-17 |
| 1912301425 | Arizona Havasu Bdm Pak LLC | Dentist | 1799 North Kiowa Blvd, Unit 109, Lake Havasu, AZ 86403 | 2014-10-13 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1750700589 | Thomas Wennergren | Pharmacist | 25 S Lake Havasu Ave, Lake Havasu City, AZ 86403 | 2014-04-09 |
| 1285997460 | Jamie L Lemire | Pharmacist | 1980 Mcculloch Blvd, Lake Havasu City, AZ 86403 | 2012-06-21 |
| 1053694448 | Goodwill of Northern Arizona | Exclusive Provider Organization | 1990 Mcculloch Blvd North, Lake Havasu City, AZ 86403 | 2011-09-22 |
| Find all providers in zip 86403 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938860 | Family Primary Care, LLC | Nurse Practitioner | 84 Acoma Blvd N Ste 106, Lake Havasu City, AZ 86403-6096 | 2020-06-26 |
| 1568016368 | Anna Marie Samons | Nurse Practitioner | 2585 San Juan Dr, Lake Havasu City, AZ 86403-3151 | 2019-07-30 |
| 1891359915 | Lauren Huljev | Nurse Practitioner | 1720 Mesquite Ave Ste 100, Lake Havasu City, AZ 86403-5602 | 2019-04-24 |
| 1447631908 | Tammy Smith | Nurse Practitioner | 2091 Smoketree Ave N Ste 103, Lake Havasu City, AZ 86403-5896 | 2015-06-10 |
| 1386047850 | Emily E Vona | Nurse Practitioner | 84 Acoma Blvd N Ste 104, Lake Havasu City, AZ 86403 | 2014-09-29 |
| 1306270145 | Megan Michelle Randall | Nurse Practitioner | 2082 Mesquite Ave Ste 106a, Lake Havasu City, AZ 86403-6710 | 2013-08-28 |
| 1265745277 | Summer Yvonne Tilgner | Nurse Practitioner | 297 S. Lake Havasu Avenue, Ste 200, Lake Havasu City, AZ 86403 | 2010-07-19 |
| 1740815901 | Cassandra Kay Kyer | Nurse Practitioner | 1810 Mesquite Ave, Lake Havasu City, AZ 86403-5886 | 2020-03-09 |
| 1396370607 | Marie Annette Ohaver | Nurse Practitioner | 2664 Jamaica Blvd S, Lake Havasu City, AZ 86406-7712 | 2020-03-06 |
| 1932747870 | Ashley Renae Powell | Nurse Practitioner | 2090 Smoketree Ave N, Lake Havasu City, AZ 86403-5806 | 2019-12-10 |
| Find all providers in LAKE HAVASU CITY | ||||
| City | LAKE HAVASU CITY |
| Zip Code | 86403 |
Please comment or provide details below to improve the information on MISTY MAPLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.