Individual
SHANA NICOLLE WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2925 W ROSE GARDEN LN STE 110, PHOENIX, AZ 85027-3135
(623) 265-7215
(833) 465-1462
Mailing address
21812 N 37TH ST, PHOENIX, AZ 85050-4952
Taxonomy
Speciality
Code
Description
License number
State
207VX0201X
Gynecologic Oncology Physician
Primary
42887
AZ
207VX0201X
Gynecologic Oncology Physician
4443
AZ
207VX0201X
Gynecologic Oncology Physician
M3796
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
519946
—
AZ
Enumeration date
08/30/2006
Last updated
09/11/2023
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