Provider Demographics
NPI:1467883975
Name:EGAN, WILMA (FNP)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:EGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WILMA
Other - Middle Name:
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1210 W ROYAL PALMS CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6635
Mailing Address - Country:US
Mailing Address - Phone:602-695-8493
Mailing Address - Fax:
Practice Address - Street 1:1210 W ROYAL PALMS CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-6635
Practice Address - Country:US
Practice Address - Phone:602-695-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN119151163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ875484Medicaid
AZZ163134Medicare PIN