Healthcare Provider Details

I. General information

NPI: 1447826482
Provider Name (Legal Business Name): STEPHANIE LYNN WANGLER MA, HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS STEPHANIE LYNN TYSIAC

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14510 W SHUMWAY DR STE 101
SUN CITY WEST AZ
85375-5815
US

IV. Provider business mailing address

14510 W SHUMWAY DR STE 101
SUN CITY WEST AZ
85375-5815
US

V. Phone/Fax

Practice location:
  • Phone: 623-760-7414
  • Fax: 623-584-4282
Mailing address:
  • Phone: 623-975-1660
  • Fax: 623-584-4282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADE7626
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: