Individual
ELIZABETH ANN WENNERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4264
(623) 876-8816
(623) 298-0168
Mailing address
13460 N 94TH DR STE J1, PEORIA, AZ 85381-4264
(623) 876-8816
(623) 298-0168
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7262
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125100
—
AZ
Enumeration date
12/17/2018
Last updated
01/18/2024
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