Healthcare Provider Details

I. General information

NPI: 1033614367
Provider Name (Legal Business Name): WILLIAM (BILL) MITCHELL WILHELM AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723
US

IV. Provider business mailing address

8763 N SAYANTE WAY
TUCSON AZ
85743-5025
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-300-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP10616
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP10616
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP10616
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: