Individual
DR. JAQUELYN RISA WILANSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2158 BUTTERFIELD COACH RD STE 100, SPRINGDALE, AR 72764-9142
(479) 757-5026
Mailing address
5555 W THUNDERBIRD RD, GLENDALE, AZ 85306-4622
(479) 521-8260
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
E-12048
AR
207Q00000X
Family Medicine Physician
E-12048
AR
208M00000X
Hospitalist Physician
Primary
60377
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2017
Last updated
06/01/2021
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