Provider Demographics
NPI:1801918883
Name:WISELY, TAMARA NOEL (WHNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:NOEL
Last Name:WISELY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27414 N 66TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7526
Mailing Address - Country:US
Mailing Address - Phone:623-825-6361
Mailing Address - Fax:
Practice Address - Street 1:3300 W CAMELBACK RD BLDG 47
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-1097
Practice Address - Country:US
Practice Address - Phone:602-639-6215
Practice Address - Fax:602-639-7830
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN083717363LW0102X
AZAP4266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ645442Medicaid