1376707406 NPI number — MRS. BARBARA G WILES FNP-BC, MSN, RN

Table of content: MRS. BARBARA G WILES FNP-BC, MSN, RN (NPI 1376707406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376707406 NPI number — MRS. BARBARA G WILES FNP-BC, MSN, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILES
Provider First Name:
BARBARA
Provider Middle Name:
G
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC, MSN, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILES
Provider Other First Name:
BOBBIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC, MSN, RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1376707406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14780 W MOUNTAIN VIEW BLVD
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
SURPRISE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85374-7280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-374-7774
Provider Business Mailing Address Fax Number:
855-420-6361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6116 EAST ARBOR AVE
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-641-5400
Provider Business Practice Location Address Fax Number:
480-218-4353
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP3103 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 370570 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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