Individual
STEPHANIE MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14155 N 83RD AVE, PEORIA, AZ 85381-5639
(623) 773-2873
Mailing address
26933 N 84TH AVE, PEORIA, AZ 85383-3890
(734) 255-9846
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP4549
AZ
363LA2200X
Adult Health Nurse Practitioner
TAP4549
AZ
Other
Enumeration date
07/09/2012
Last updated
08/03/2012
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