Healthcare Provider Details

I. General information

NPI: 1508035551
Provider Name (Legal Business Name): CHERYL A WIEWECK NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 S VAL VISTA DR
GILBERT AZ
85297-7323
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-6345
  • Fax:
Mailing address:
  • Phone: 602-933-1814
  • Fax: 602-266-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN098549
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number098549
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: