Individual
NIJERA SHANEL WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17235 N 75TH AVE STE F100, GLENDALE, AZ 85308-0871
(480) 641-1165
Mailing address
17235 N 75TH AVE, GLENDALE, AZ 85308-0831
(480) 641-1165
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
AZ
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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