Search › Arizona › 164W00000X
Tana Jackson-Wilson
NPI 1639504152 · on the registry since 2013
Practice
- Address
- 4612 N 28th St
Camelback Hs Medically Fragile
Phoenix, AZ 85016 - Phone
- (602) 764-7122
- Clinicians at this address
- 13
Registry record
- Primary taxonomy
- 164W00000X
164W00000X
- Also registered as
- 164W00000X
- Licence states on file
- AZ, IL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2013-09-04
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona