Healthcare Provider Details

I. General information

NPI: 1851587109
Provider Name (Legal Business Name): KATHERINE GOULD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 W GRANT RD
TUCSON AZ
85745-1433
US

IV. Provider business mailing address

127 S 5TH AVE
TUCSON AZ
85701-2005
US

V. Phone/Fax

Practice location:
  • Phone: 520-622-8204
  • Fax: 520-622-8216
Mailing address:
  • Phone: 520-327-4505
  • Fax: 520-202-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN035832
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: