Healthcare Provider Details

I. General information

NPI: 1740104736
Provider Name (Legal Business Name): VICTORIA WENZEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10880 N 32ND ST
PHOENIX AZ
85028-3200
US

IV. Provider business mailing address

4702 E DECATUR ST
MESA AZ
85205-6300
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-9605
  • Fax:
Mailing address:
  • Phone: 480-206-9605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN192826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: