Basic Information
Provider Information
NPI: 1689067969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILKINS
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ACNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2510 W DUNLAP AVE
Address2: SUITE 290
City: PHOENIX
State: AZ
PostalCode: 850212737
CountryCode: US
TelephoneNumber: 6027890344
FaxNumber: 6027898389
Practice Location
Address1: 2510 W DUNLAP AVE
Address2: SUITE 290
City: PHOENIX
State: AZ
PostalCode: 850212737
CountryCode: US
TelephoneNumber: 6027890344
FaxNumber: 6027898389
Other Information
ProviderEnumerationDate: 03/11/2015
LastUpdateDate: 03/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XAP7692AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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