Provider Demographics
NPI:1952822082
Name:MCDANIEL, KATRINA (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2250 W SOUTHERN AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4736
Mailing Address - Country:US
Mailing Address - Phone:480-835-5532
Mailing Address - Fax:480-962-0106
Practice Address - Street 1:6832 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3755
Practice Address - Country:US
Practice Address - Phone:480-830-8333
Practice Address - Fax:480-830-8390
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY020924363A00000X
AZ7837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant