Provider Demographics
NPI:1215374509
Name:GILBERTSON, WENDY S (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:S
Last Name:GILBERTSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2153
Mailing Address - Country:US
Mailing Address - Phone:602-923-5764
Mailing Address - Fax:
Practice Address - Street 1:3805 E BELL RD
Practice Address - Street 2:STE 1100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2105
Practice Address - Country:US
Practice Address - Phone:602-923-5764
Practice Address - Fax:602-923-5755
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily