Healthcare Provider Details

I. General information

NPI: 1144415639
Provider Name (Legal Business Name): KATIE MARIE ELIZABETH NEMITZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E BUTLER DR APT D3
PHOENIX AZ
85020-3760
US

IV. Provider business mailing address

1130 E BUTLER DR APT D3
PHOENIX AZ
85020-3760
US

V. Phone/Fax

Practice location:
  • Phone: 307-331-5096
  • Fax:
Mailing address:
  • Phone: 307-331-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number273588
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159226-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: