Individual
MRS. LAURA MARY WILDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-C
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-1537
(602) 933-1461
Mailing address
3200 E CAMELBACK RD STE 250, PHOENIX, AZ 85018-2327
(602) 933-1814
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP4110
AZ
363LF0000X
Family Nurse Practitioner
TAP4110
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
648766
—
AZ
Enumeration date
07/07/2011
Last updated
04/04/2018
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