Provider Demographics
NPI:1538276035
Name:PERIC-KNOWLTON, WLATKA (NP, MSN)
Entity type:Individual
Prefix:MS
First Name:WLATKA
Middle Name:
Last Name:PERIC-KNOWLTON
Suffix:
Gender:F
Credentials:NP, MSN
Other - Prefix:MS
Other - First Name:WLATKA
Other - Middle Name:
Other - Last Name:PERIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, MSN
Mailing Address - Street 1:4458 E JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-3461
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:480-324-1776
Practice Address - Street 1:CARL T. HAYDEN VA MEDICAL CENTER
Practice Address - Street 2:650 E. INDIAN SCHOOL ROAD (CS111E-2)
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1892
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-200-6004
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN037759363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health