Provider Demographics
NPI:1578040077
Name:HAILEY, KATRINA MARIE (FNP, MSN)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:HAILEY
Suffix:
Gender:F
Credentials:FNP, MSN
Other - Prefix:MS
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:LAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1826 E HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4645
Mailing Address - Country:US
Mailing Address - Phone:602-689-0867
Mailing Address - Fax:
Practice Address - Street 1:13555 W MCDOWELL RD STE 304
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2629
Practice Address - Country:US
Practice Address - Phone:623-935-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN174012163W00000X
AZAP11624363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily