Healthcare Provider Details

I. General information

NPI: 1033741665
Provider Name (Legal Business Name): KATHERINE J. WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8812 W MARIPOSA GRANDE
PEORIA AZ
85383-1204
US

IV. Provider business mailing address

8812 W MARIPOSA GRANDE
PEORIA AZ
85383-1204
US

V. Phone/Fax

Practice location:
  • Phone: 602-299-6366
  • Fax:
Mailing address:
  • Phone: 602-299-6366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN138584
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251761
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: