Healthcare Provider Details

I. General information

NPI: 1578414595
Provider Name (Legal Business Name): EMILEE WAYNE ND PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

IV. Provider business mailing address

1910 S STAPLEY DR STE 120
MESA AZ
85204-6676
US

V. Phone/Fax

Practice location:
  • Phone: 480-648-2353
  • Fax: 866-561-0206
Mailing address:
  • Phone: 480-648-2353
  • Fax: 866-561-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: EMILEE WAYNE
Title or Position: PHYSICIAN
Credential: NMD
Phone: 480-648-2353