Healthcare Provider Details

I. General information

NPI: 1891965810
Provider Name (Legal Business Name): ELAINE M KATZMAN NP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N 16TH ST SUITE #E-110
PHOENIX AZ
85016-5121
US

IV. Provider business mailing address

4620 N 16TH ST SUITE #E-110
PHOENIX AZ
85016-5121
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-2770
  • Fax: 866-534-1701
Mailing address:
  • Phone: 602-264-2770
  • Fax: 866-534-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN050118
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: