Provider Demographics
NPI:1073556924
Name:MCGUIRE, KATRINA NICHOLE (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:NICHOLE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N SWAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6300
Mailing Address - Country:US
Mailing Address - Phone:520-324-2030
Mailing Address - Fax:520-445-6019
Practice Address - Street 1:2810 N SWAN RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6300
Practice Address - Country:US
Practice Address - Phone:520-324-2030
Practice Address - Fax:520-445-6019
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53090207L00000X
ALPA-420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934624Medicaid
AL009934624Medicaid
AL051557483MCGMedicare ID - Type Unspecified