Provider Demographics
NPI:1427368240
Name:WING, AMY E (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:WING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-316-9272
Practice Address - Street 1:3011 S LINDSAY RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4333
Practice Address - Country:US
Practice Address - Phone:480-726-2500
Practice Address - Fax:480-726-2131
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7629170001332B00000X
AZ7046960001332B00000X
AZ7045160001332B00000X
AZ7057360001332B00000X
AZ7209350001332B00000X
AZ7047150001332B00000X
AZ7034950001332B00000X
AZ3141363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies