Provider Demographics
NPI:1790235117
Name:MAWHINNEY, KATHERYN (RN, CRNA)
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:
Last Name:MAWHINNEY
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CRNA
Mailing Address - Street 1:807 PROMONTORY DR W
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7361
Mailing Address - Country:US
Mailing Address - Phone:714-357-7529
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7122367500000X
CA95000754367500000X
CA100531282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1063823953OtherNPI