Provider Demographics
NPI:1043192206
Name:BAUMAN, STACY (RN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:STUDDARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3993 S 178TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-8042
Mailing Address - Country:US
Mailing Address - Phone:630-347-1167
Mailing Address - Fax:
Practice Address - Street 1:15151 W CENTERRA DR S
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2956
Practice Address - Country:US
Practice Address - Phone:623-772-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ296039163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse