Basic Information
| Provider Information | |||||||||
| NPI: | 1588226526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILHELM | ||||||||
| FirstName: | ASHLYNN ROSE | ||||||||
| MiddleName: | JEANETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 N 32ND ST STE 201A | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850183397 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 N 32ND ST STE 201A | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850183397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807995079 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2019 | ||||||||
| LastUpdateDate: | 07/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 19-91915 | AZ | Y |
No ID Information.