Provider Demographics
NPI:1801493184
Name:WILSON, STEPHANIE LEIGH
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 E EARLL DR BLDG C
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7230
Mailing Address - Country:US
Mailing Address - Phone:480-912-4747
Mailing Address - Fax:480-422-2690
Practice Address - Street 1:7285 E EARLL DR BLDG C
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7230
Practice Address - Country:US
Practice Address - Phone:480-912-4747
Practice Address - Fax:480-422-2690
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253670363LA2100X
AZRN189915163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse