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General NPI Number Information
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NPI Number | 1689052557
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Entity Type | Individual
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Provider Name | SIERRA WENSMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2015
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 1925 W ORANGE GROVE RD STE 302
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City | TUCSON
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State | AZ
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Zip | 85704
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Country | US
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Telephone | 520-797-3888
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Fax | 520-797-2196
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Provider Business Mailing Address
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Address Line | 1925 W ORANGE GROVE RD STE 302
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City | TUCSON
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State | AZ
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Zip | 85704-1152
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Country | US
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Telephone | 520-797-3888
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Fax | 520-797-2196
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 55554
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R75024
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License Number State | AZ
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