Healthcare Provider Details

I. General information

NPI: 1467481135
Provider Name (Legal Business Name): KATHERINE J WEIDENBACH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 E IRONWOOD SQUARE DR STE 110
SCOTTSDALE AZ
85258-4582
US

IV. Provider business mailing address

9500 E IRONWOOD SQUARE DR STE 110
SCOTTSDALE AZ
85258-4582
US

V. Phone/Fax

Practice location:
  • Phone: 480-948-8400
  • Fax: 480-948-8401
Mailing address:
  • Phone: 480-948-8400
  • Fax: 480-948-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN114116
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: