Provider Demographics
NPI:1144415639
Name:NEMITZ, KATIE MARIE ELIZABETH (RN)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:MARIE ELIZABETH
Last Name:NEMITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E BUTLER DR APT D3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-3760
Mailing Address - Country:US
Mailing Address - Phone:307-331-5096
Mailing Address - Fax:
Practice Address - Street 1:1130 E BUTLER DR APT D3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3760
Practice Address - Country:US
Practice Address - Phone:307-331-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ273588163WC0200X
WI159226-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35039600Medicaid