Provider Demographics
NPI:1679300289
Name:WILSON, RONDA REAHJEAN (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:REAHJEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6411
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-6411
Mailing Address - Country:US
Mailing Address - Phone:623-330-8780
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 6411
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85261-6411
Practice Address - Country:US
Practice Address - Phone:623-330-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ241450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine