Provider Demographics
NPI:1326867110
Name:UNICORN WINGS
Entity type:Organization
Organization Name:UNICORN WINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADULOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:480-226-0998
Mailing Address - Street 1:1932 E MARILYN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3942
Mailing Address - Country:US
Mailing Address - Phone:480-226-0998
Mailing Address - Fax:602-603-5323
Practice Address - Street 1:1932 E MARILYN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3942
Practice Address - Country:US
Practice Address - Phone:480-226-0998
Practice Address - Fax:602-603-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty