Individual
GENA R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1920 E CAMBRIDGE AVE STE 304, PHOENIX, AZ 85006
(602) 933-4363
(602) 933-2415
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1813
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
AP6776
AZ
363LP0200X
Pediatric Nurse Practitioner
RN060806
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
863177
—
AZ
Enumeration date
03/31/2006
Last updated
07/25/2018
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