Provider Demographics
NPI:1154389153
Name:WILLENBORG, CATHERINE (PAC)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:WILLENBORG
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:WILLENBORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:8601 N SENDERO TRES M
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2258
Mailing Address - Country:US
Mailing Address - Phone:775-771-1824
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5499
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10627363A00000X
NVPA972363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508855Medicaid
NVV102135Medicare PIN
Q65849Medicare UPIN