Healthcare Provider Details

I. General information

NPI: 1386889517
Provider Name (Legal Business Name): KATHARINE A KAZAKA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N STONEHENGE DR STE 104
GILBERT AZ
85233-1244
US

IV. Provider business mailing address

1550 N STONEHENGE DR STE 104
GILBERT AZ
85233-1244
US

V. Phone/Fax

Practice location:
  • Phone: 480-962-7922
  • Fax: 480-962-7944
Mailing address:
  • Phone: 480-962-7922
  • Fax: 480-962-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN131683
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP3612
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: