Provider Demographics
NPI:1689671695
Name:SMITH, KATHARINE ANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 N SWALLOW LN
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-3924
Mailing Address - Country:US
Mailing Address - Phone:480-892-4691
Mailing Address - Fax:480-892-4691
Practice Address - Street 1:2610 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-8436
Practice Address - Country:US
Practice Address - Phone:480-892-8400
Practice Address - Fax:480-892-9533
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036653367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRNA 39793AMedicare ID - Type UnspecifiedMARICOPA COUNTY
AZCRNA 36219Medicare ID - Type UnspecifiedYAVAPAI COUNTY
AZRNA 39793CMedicare ID - Type UnspecifiedALL OTHER COUNTIES
AZRNA 39793BMedicare ID - Type UnspecifiedYUMA COUNTY
AZ32525Medicare UPIN