Individual
TANYA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4233 S 58TH DR, PHOENIX, AZ 85043-6414
(480) 389-7983
Mailing address
4233 S 58TH DR, PHOENIX, AZ 85043-6414
(480) 389-7983
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
05/28/2025
Last updated
05/28/2025
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