Provider Demographics
NPI:1538718150
Name:ARCHULETA, KATIE DAWN (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:DAWN
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NORTH HIGHWAY 177
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:AZ
Mailing Address - Zip Code:85137
Mailing Address - Country:US
Mailing Address - Phone:520-363-5517
Mailing Address - Fax:520-363-5017
Practice Address - Street 1:651 SENATOR CHASTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:AZ
Practice Address - Zip Code:85137
Practice Address - Country:US
Practice Address - Phone:520-363-5517
Practice Address - Fax:520-363-5017
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse