Basic Information
Provider Information
NPI: 1871846816
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WYER
FirstName: PAIGE
MiddleName: NICOLE
NamePrefix:  
NameSuffix:  
Credential: MSN FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3030 N CENTRAL AVE STE 1001
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850122716
CountryCode: US
TelephoneNumber: 6024064786
FaxNumber: 9166364358
Practice Location
Address1: 1727 W FRYE RD STE 210
Address2:  
City: CHANDLER
State: AZ
PostalCode: 85224
CountryCode: US
TelephoneNumber: 4807287564
FaxNumber: 4807282253
Other Information
ProviderEnumerationDate: 10/15/2012
LastUpdateDate: 07/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP2300XAP4706AZN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
363LF0000XAP4706AZY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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