Healthcare Provider Details

I. General information

NPI: 1194169102
Provider Name (Legal Business Name): PEARLIE WILSON-NATAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 08/12/2022
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 5TH ST
DOUGLAS AZ
85607-2859
US

IV. Provider business mailing address

198 S CORONADO DR SUITE B
SIERRA VISTA AZ
85635-6354
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-7659
  • Fax: 520-364-8541
Mailing address:
  • Phone: 520-439-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4841
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: