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General NPI Number Information
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NPI Number | 1861183162
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Entity Type | Individual
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Provider Name | WANDA PAMELA GARCIA MACIAS FNP
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Gender | Female
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2851 S AVENUE B BLDG 20
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City | YUMA
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State | AZ
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Zip | 85364-7726
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Country | US
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Telephone | 928-336-2434
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Fax | 928-336-2435
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Provider Business Mailing Address
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Address Line | 2400 S AVENUE A
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City | YUMA
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State | AZ
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Zip | 85364-7127
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Country | US
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Telephone | 928-344-2000
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN212958
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 292954
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License Number State | AZ
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