Healthcare Provider Details

I. General information

NPI: 1538718150
Provider Name (Legal Business Name): KATIE DAWN ARCHULETA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 SENATOR CHASTAIN DRIVE
KEARNY AZ
85137
US

IV. Provider business mailing address

701 NORTH HIGHWAY 177
KEARNY AZ
85137
US

V. Phone/Fax

Practice location:
  • Phone: 520-363-5517
  • Fax: 520-363-5017
Mailing address:
  • Phone: 520-363-5517
  • Fax: 520-363-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN152964
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: