Provider Demographics
NPI:1083984694
Name:SONORA FAMILY CARE
Entity Type:Organization
Organization Name:SONORA FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, ACNP-BC
Authorized Official - Phone:520-335-6271
Mailing Address - Street 1:4996 E MEDITERRANEAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2434
Mailing Address - Country:US
Mailing Address - Phone:520-335-6271
Mailing Address - Fax:520-335-6316
Practice Address - Street 1:4996 E MEDITERRANEAN DR STE D
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2434
Practice Address - Country:US
Practice Address - Phone:520-335-6271
Practice Address - Fax:520-335-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty