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General NPI Number Information
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NPI Number | 1891493904
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Entity Type | Organization
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Legal Business Name | AGELESS WOMEN'S HEALTH AZ LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 2451 E BASELINE RD STE 400
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City | GILBERT
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State | AZ
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Zip | 85234-2472
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Country | US
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Telephone | 480-443-0341
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Fax |
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Provider Business Mailing Address
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Address Line | 10501 W GOWAN RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89129-6602
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Country | US
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Telephone | 725-204-6055
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Fax |
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Authorized Official
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Title or Position | BUSINESS OPERATIONS DIRECTOR
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Name | AMANDA WILKINSON
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Credential |
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Telephone | 602-796-2559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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