Healthcare Provider Details

I. General information

NPI: 1487940524
Provider Name (Legal Business Name): KATHERINE LILLIAN FORD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KATHERINE LILLIAN MCLAUGHLIN

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20333 N 19TH AVE STE 100
PHOENIX AZ
85027-3602
US

IV. Provider business mailing address

5281 N 99TH AVE STE 100
GLENDALE AZ
85305-2209
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-516-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number092761-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4108
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1394
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: