MEDICARE: KATRINA MCDANIEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	020924	NY
2	363A00000X	Physician Assistant	7837	AZ

General Provider Information

NPI Number	:	1952822082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA MCDANIEL PA-C

Provider Business Mailing Address
First Line	:	6832 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3755
Country	:	US
Telephone Number	:	480-830-8333
Fax Number	:	480-962-0106

Provider Business Practice Location Address
First Line	:	6832 E BROWN RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-3755
Country	:	US
Telephone Number	:	480-830-8333
Fax Number	:	480-830-8390

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	06/21/2024

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