Provider Demographics
NPI:1760136600
Name:WEBER, KAITLYN (RN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WEBER
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 1:3437 JAMAICA BLVD S
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-5507
Mailing Address - Country:US
Mailing Address - Phone:928-854-7283
Mailing Address - Fax:
Practice Address - Street 1:3437 JAMAICA BLVD S
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-5507
Practice Address - Country:US
Practice Address - Phone:928-854-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN177363163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool