Provider Demographics
NPI:1073549960
Name:WILSON, JANE N (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:NOVEMBER
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:1217 N MILLER RD
Mailing Address - Street 2:UNIT 34
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3659
Mailing Address - Country:US
Mailing Address - Phone:480-656-3390
Mailing Address - Fax:602-263-1692
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:OB/GYN DEPARTMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:602-263-1692
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079372163W00000X
AZ153367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ440941Medicaid
AZ440941Medicaid
8EB491Medicare ID - Type Unspecified