Provider Demographics
NPI:1508075664
Name:NIELSEN, WENDY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 S LOS ALAMOS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7225
Mailing Address - Country:US
Mailing Address - Phone:602-292-9065
Mailing Address - Fax:480-248-9275
Practice Address - Street 1:1718 S LOS ALAMOS
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7225
Practice Address - Country:US
Practice Address - Phone:602-292-9065
Practice Address - Fax:480-248-9275
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN057488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN057488OtherAZ STATE BOARD OF NURSING