MEDICARE: JANICE WENTWORTH 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	287866	AZ

General Provider Information

NPI Number	:	1861190993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE WENTWORTH APRN

Provider Business Mailing Address
First Line	:	9245 E GUADALUPE RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-2149
Country	:	US
Telephone Number	:	480-608-4742
Fax Number	:	480-986-4462

Provider Business Practice Location Address
First Line	:	9245 E GUADALUPE RD STE 108
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-2149
Country	:	US
Telephone Number	:	480-608-4742
Fax Number	:	480-986-4462

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

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	05/12/2026

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Directions to “ JANICE WENTWORTH APRN” Practice Location

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