Individual
LARISSA DOHN WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8705 E MCDOWELL RD, SCOTTSDALE, AZ 85257-3909
(480) 882-4545
(480) 946-6997
Mailing address
7500 N DREAMY DRAW DR STE 145, PHOENIX, AZ 85020-4668
(480) 882-4545
(480) 882-5814
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7140
AZ
363AM0700X
Medical Physician Assistant
7140
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
435328
—
AZ
Enumeration date
09/11/2018
Last updated
03/14/2023
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