Healthcare Provider Details

I. General information

NPI: 1669079083
Provider Name (Legal Business Name): WILHELMINA SAGOE ANNOR DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 E THOMAS RD STE 100
SCOTTSDALE AZ
85251-7033
US

IV. Provider business mailing address

6380 E THOMAS RD STE 100
SCOTTSDALE AZ
85251-7033
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-0606
  • Fax: 480-607-6695
Mailing address:
  • Phone: 480-607-0606
  • Fax: 480-607-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number246626
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number246626
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: