Healthcare Provider Details

I. General information

NPI: 1033490891
Provider Name (Legal Business Name): KATIE R LENHART PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S WATSON RD STE C-104
BUCKEYE AZ
85326-8689
US

IV. Provider business mailing address

3815 E BELL RD STE 2200
PHOENIX AZ
85032-2139
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-7559
  • Fax: 662-326-6401
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002204
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: