Basic Information
| Provider Information | |||||||||
| NPI: | 1538276035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERIC-KNOWLTON | ||||||||
| FirstName: | WLATKA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP, MSN | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PERIC | ||||||||
| OtherFirstName: | WLATKA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP, MSN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4458 E JUANITA AVE | ||||||||
| Address2: | |||||||||
| City: | HIGLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852363461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 4803241776 | ||||||||
| Practice Location | |||||||||
| Address1: | CARL T. HAYDEN VA MEDICAL CENTER | ||||||||
| Address2: | 650 E. INDIAN SCHOOL ROAD (CS111E-2) | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 6022006004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | RN037759 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.