Healthcare Provider Details

I. General information

NPI: 1124981212
Provider Name (Legal Business Name): SEQUYOAH JAMIE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13026 N CAVE CREEK RD STE 204
PHOENIX AZ
85022-5199
US

IV. Provider business mailing address

13026 N CAVE CREEK RD STE 204
PHOENIX AZ
85022-5199
US

V. Phone/Fax

Practice location:
  • Phone: 623-806-0929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: