Provider Demographics
NPI:1508247586
Name:WILSON, BARBARA ANN
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:ANN
Other - Last Name:KANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2155 E LIBERTY LN APT 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8129
Mailing Address - Country:US
Mailing Address - Phone:480-469-4376
Mailing Address - Fax:
Practice Address - Street 1:2155 E LIBERTY LN APT 121
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8129
Practice Address - Country:US
Practice Address - Phone:480-469-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA77800205OtherAHCCCS ID# MERCY CARE