Provider Demographics
NPI:1487701512
Name:WILEY, LUZ MARIA (NP)
Entity type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MARIA
Last Name:WILEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451S AVENUE A A104
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7189
Mailing Address - Country:US
Mailing Address - Phone:928-336-2170
Mailing Address - Fax:928-336-2174
Practice Address - Street 1:1220 W 24TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8705
Practice Address - Country:US
Practice Address - Phone:928-329-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2595363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health