Healthcare Provider Details

I. General information

NPI: 1588041156
Provider Name (Legal Business Name): BARBARA WYSOCKI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA MARIE WARD R.N.

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST
PHOENIX AZ
85006-2754
US

IV. Provider business mailing address

1331 N 7TH ST
PHOENIX AZ
85006-2754
US

V. Phone/Fax

Practice location:
  • Phone: 602-307-0070
  • Fax: 602-307-0080
Mailing address:
  • Phone: 602-307-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN164787
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8373
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: