Provider Demographics
NPI:1144246869
Name:WALES, ANITA MCDUFF (NNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MCDUFF
Last Name:WALES
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:ROBYN
Other - Last Name:WALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:STE 375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3420
Mailing Address - Country:US
Mailing Address - Phone:602-277-4161
Mailing Address - Fax:602-266-3481
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:STE 375
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3420
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:602-266-3481
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45501363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ541757Medicaid