=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033490891
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATIE R LENHART PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2011
-----------------------------------------------------
Last Update Date | 06/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 S WATSON RD STE C-104
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326-8689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-251-7559
-----------------------------------------------------
Fax | 662-326-6401
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3815 E BELL RD STE 2200
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85032-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-633-3848
-----------------------------------------------------
Fax | 602-633-3841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 002204
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------