MEDICARE: KATHERINE CAROL ELIZABETH WALZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	7242	CT
2	363LF0000X	Family Nurse Practitioner	AP7611	AZ
3	363LF0000X	Family Nurse Practitioner	RN163732	AZ

General Provider Information

NPI Number	:	1447642624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE CAROL ELIZABETH WALZ APRN

Provider Business Mailing Address
First Line	:	4824 E BASELINE RD STE 140
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4680
Country	:	US
Telephone Number	:	480-969-4040
Fax Number	:	480-295-3722

Provider Business Practice Location Address
First Line	:	4838 E BASELINE RD STE 110
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-4674
Country	:	US
Telephone Number	:	480-969-4040
Fax Number	:	480-295-3722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	10/20/2025

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