Healthcare Provider Details

I. General information

NPI: 1003742404
Provider Name (Legal Business Name): JOLENE WALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 S MCCLINTOCK DR
TEMPE AZ
85282-5877
US

IV. Provider business mailing address

18621 W ONYX AVE
WADDELL AZ
85355-4449
US

V. Phone/Fax

Practice location:
  • Phone: 602-890-9497
  • Fax: 928-460-8476
Mailing address:
  • Phone: 602-388-0068
  • Fax: 928-460-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN201326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: