Healthcare Provider Details

I. General information

NPI: 1518011535
Provider Name (Legal Business Name): KATHERINE WEIDNER DONALD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10965 E PERALTA RD
GOLD CANYON AZ
85218-4799
US

IV. Provider business mailing address

9889 E WINDY PASS TRL
GOLD CANYON AZ
85218-4950
US

V. Phone/Fax

Practice location:
  • Phone: 480-982-1110
  • Fax: 480-288-4490
Mailing address:
  • Phone: 480-982-6647
  • Fax: 480-288-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN108358
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: