Provider Demographics
NPI:1609541333
Name:WHEAT, LAWANDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:WHEAT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20216
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85036-0216
Mailing Address - Country:US
Mailing Address - Phone:480-712-4600
Mailing Address - Fax:602-428-7045
Practice Address - Street 1:1910 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7592
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:602-428-7045
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-10-20
Deactivation Date:2021-09-30
Deactivation Code:
Reactivation Date:2021-10-20
Provider Licenses
StateLicense IDTaxonomies
AZF08210427363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily