Healthcare Provider Details

I. General information

NPI: 1689387573
Provider Name (Legal Business Name): WENDY NELSON DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR STE A111
GILBERT AZ
85297-7319
US

IV. Provider business mailing address

4660 S GRIFFITH WAY
GILBERT AZ
85297-8267
US

V. Phone/Fax

Practice location:
  • Phone: 480-608-0058
  • Fax:
Mailing address:
  • Phone: 480-608-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number285559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: