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General NPI Number Information
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NPI Number | 1083984694
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Entity Type | Organization
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Legal Business Name | SONORA FAMILY CARE
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 4996 E MEDITERRANEAN DR STE D
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2434
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Country | US
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Telephone | 520-335-6271
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Fax | 520-335-6316
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Provider Business Mailing Address
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Address Line | 4996 E MEDITERRANEAN DR STE D
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-2434
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Country | US
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Telephone | 520-335-6271
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Fax | 520-335-6316
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN WISTER
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Credential | FNP-BC, ACNP-BC
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Telephone | 520-335-6271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP3956
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License Number State | AZ
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