Provider Demographics
NPI:1962577403
Name:WILSON, HEIDI EILEEN (MSN, ANP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:EILEEN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6296 E GRANT RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5876
Mailing Address - Country:US
Mailing Address - Phone:520-298-3321
Mailing Address - Fax:702-804-3655
Practice Address - Street 1:6296 E GRANT RD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5876
Practice Address - Country:US
Practice Address - Phone:520-298-3321
Practice Address - Fax:888-978-2518
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1753363LA2200X
AZRN067232/AP1753363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ873134Medicaid
AZQ21083Medicare UPIN
Q21083Medicare UPIN
82728Medicare ID - Type Unspecified
AZZ197889Medicare PIN