Provider Demographics
NPI:1003042961
Name:WAX, KARLA D (NP-C)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:D
Last Name:WAX
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N 7TH ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2754
Mailing Address - Country:US
Mailing Address - Phone:602-254-3151
Mailing Address - Fax:602-256-9581
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 275
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-254-3151
Practice Address - Fax:602-256-9581
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAT3373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily