Healthcare Provider Details

I. General information

NPI: 1609541333
Provider Name (Legal Business Name): LAWANDA WHEAT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date: 09/30/2021
Reactivation Date: 10/20/2021

III. Provider practice location address

1910 E SOUTHERN AVE
TEMPE AZ
85282-7592
US

IV. Provider business mailing address

PO BOX 20216
PHOENIX AZ
85036-0216
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-4600
  • Fax: 602-428-7045
Mailing address:
  • Phone: 480-712-4600
  • Fax: 602-428-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08210427
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: