Provider Demographics
NPI:1881565174
Name:WHILD CHILD AESTHETICS AND WELLNESS
Entity type:Organization
Organization Name:WHILD CHILD AESTHETICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:602-886-4034
Mailing Address - Street 1:2716 E CANYON PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5102
Mailing Address - Country:US
Mailing Address - Phone:602-886-4034
Mailing Address - Fax:480-769-9095
Practice Address - Street 1:797 N ALMA SCHOOL RD STE A-10
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3664
Practice Address - Country:US
Practice Address - Phone:602-886-4034
Practice Address - Fax:480-769-9095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty