Provider Demographics
NPI:1447642624
Name:WALZ, KATHERINE CAROL ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CAROL ELIZABETH
Last Name:WALZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:4824 E BASELINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4680
Mailing Address - Country:US
Mailing Address - Phone:480-969-4040
Mailing Address - Fax:480-295-3722
Practice Address - Street 1:4824 E BASELINE RD STE 140
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4680
Practice Address - Country:US
Practice Address - Phone:480-969-4040
Practice Address - Fax:480-295-3722
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN163732363LF0000X
AZAP7611363LF0000X
CT7242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily