Provider Demographics
NPI:1467485169
Name:WAGELIE STEFFEN, AMY (MD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:WAGELIE STEFFEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1912
Mailing Address - Country:US
Mailing Address - Phone:520-325-5701
Mailing Address - Fax:520-325-0128
Practice Address - Street 1:2960 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1912
Practice Address - Country:US
Practice Address - Phone:520-325-5701
Practice Address - Fax:520-325-0128
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ35704OtherARIZONA MEDICAL LICENSE