Healthcare Provider Details

I. General information

NPI: 1306829304
Provider Name (Legal Business Name): CATHERINE GAIL TIWALD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 W BELL RD SUITE 1
GLENDALE AZ
85308-3718
US

IV. Provider business mailing address

7502 W WILLOW AVE
PEORIA AZ
85381-4014
US

V. Phone/Fax

Practice location:
  • Phone: 602-547-1600
  • Fax: 602-547-1622
Mailing address:
  • Phone: 623-326-6172
  • Fax: 602-547-1622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN 048187
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: