Provider Demographics
NPI:1326038308
Name:WILKEY, NINA W (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:W
Last Name:WILKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:100
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-978-1500
Mailing Address - Fax:602-978-0409
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG M 178
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-588-7100
Practice Address - Fax:602-843-1270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14399207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ272732Medicaid
D37840Medicare UPIN
WCKHB07Medicare ID - Type Unspecified