Healthcare Provider Details

I. General information

NPI: 1891079950
Provider Name (Legal Business Name): WENDY S MEDFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2011
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9261 W VAN BUREN ST
TOLLESON AZ
85353-2941
US

IV. Provider business mailing address

6162 S 258TH DR
BUCKEYE AZ
85326-2150
US

V. Phone/Fax

Practice location:
  • Phone: 623-936-9740
  • Fax: 623-936-9757
Mailing address:
  • Phone: 801-694-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN115980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: