Stephanie Marie Wilson

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

AP4549 Issued in AZ

Practice address

14155 N 83Rd Ave
Peoria, AZ 85381-5639

Phone

(623) 773-2873

NPI assigned

Jul 9, 2012

Last updated

Aug 3, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343952000000",
    "number": "1972868677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26933 N 84TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853833890",
            "telephone_number": "734-255-9846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14155 N 83RD AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853815639",
            "telephone_number": "623-773-2873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-09",
        "last_updated": "2012-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "TAP4549",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "AP4549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charronda Willoughby
• Darian E Wilson, DPM
• Hyon Su Wilson, ACNPC-AG
• Nicole Wilson, COTA/L
• Sara A Wilson, PA-C
• Susan Ann Wilson, RN, BSN
• Tiffany M Wilson, APRN
• Ciandra Winkels
• Courtney Nicole Winters, PA
• Hal Robert Winters, DC

• Adult Health Nurse Practitioner in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Adult Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.