Healthcare Provider Details

I. General information

NPI: 1518770114
Provider Name (Legal Business Name): ARIANA GRACIELA WYLIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W THUNDERBIRD RD
PHOENIX AZ
85023-6307
US

IV. Provider business mailing address

15881 W DESERT HOLLOW DR
SURPRISE AZ
85387-4470
US

V. Phone/Fax

Practice location:
  • Phone: 623-915-8900
  • Fax:
Mailing address:
  • Phone: 480-415-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number303704
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: