Provider Demographics
NPI:1760259758
Name:NANTZ, KATHERYN ROSE
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ROSE
Last Name:NANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 W BLUEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1341
Mailing Address - Country:US
Mailing Address - Phone:602-999-4354
Mailing Address - Fax:
Practice Address - Street 1:5441 W BLUEFIELD AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1341
Practice Address - Country:US
Practice Address - Phone:602-999-4354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program