1710854500 NPI number — STAPLETON INTEGRATIVE WELLNESS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710854500 NPI number — STAPLETON INTEGRATIVE WELLNESS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAPLETON INTEGRATIVE WELLNESS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710854500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15411 W WADDELL RD
Provider Second Line Business Mailing Address:
STE 102 PMB 1213
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85379-5170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-562-1992
Provider Business Mailing Address Fax Number:
602-584-4934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17751 W VILLA CHULA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85387-4049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-562-1992
Provider Business Practice Location Address Fax Number:
602-584-4934
Provider Enumeration Date:
10/17/2025

Additional Information

Authorized Official

Authorized Official Last Name:
STAPLETON
Authorized Official First Name:
MARISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER / NURSE PRACTITIONER
Authorized Official Telephone Number:
602-562-1992

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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