Provider Demographics
NPI:1386889517
Name:KAZAKA, KATHARINE A (NP)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:A
Last Name:KAZAKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N STONEHENGE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1244
Mailing Address - Country:US
Mailing Address - Phone:480-962-7922
Mailing Address - Fax:480-962-7944
Practice Address - Street 1:1550 N STONEHENGE DR STE 104
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1244
Practice Address - Country:US
Practice Address - Phone:480-962-7922
Practice Address - Fax:480-962-7944
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN131683163WP0808X
AZAP3612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health