Healthcare Provider Details

I. General information

NPI: 1942760624
Provider Name (Legal Business Name): KATRINA MARIE SEXAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 MAIN ST
TUBA CITY AZ
86045
US

IV. Provider business mailing address

1113 E WINDSOR DR
GILBERT AZ
85296-4258
US

V. Phone/Fax

Practice location:
  • Phone: 866-976-5341
  • Fax:
Mailing address:
  • Phone: 608-498-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64773
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: