MEDICARE: MONTANA ASHLEY WILSON APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	232437	AZ
2	363LA2100X	Acute Care Nurse Practitioner	232437	AZ

General Provider Information

NPI Number	:	1285509927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTANA ASHLEY WILSON APRN

Provider Business Mailing Address
First Line	:	PO BOX 860912
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55486-0912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 E MAYO BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-4502
Country	:	US
Telephone Number	:	480-342-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2025
Last Update Date	:	12/10/2025

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