Healthcare Provider Details

I. General information

NPI: 1689671695
Provider Name (Legal Business Name): KATHARINE ANNE SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 E UNIVERSITY DR
MESA AZ
85213-8436
US

IV. Provider business mailing address

566 N SWALLOW LN
HIGLEY AZ
85236-3924
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-8400
  • Fax: 480-892-9533
Mailing address:
  • Phone: 480-892-4691
  • Fax: 480-892-4691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN036653
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: