Provider Demographics
NPI:1861476988
Name:WEITZEL, CATHERINE A (RN ARNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:WEITZEL
Suffix:
Gender:F
Credentials:RN ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 E 21ST ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3545
Mailing Address - Country:US
Mailing Address - Phone:316-630-8444
Mailing Address - Fax:316-630-8449
Practice Address - Street 1:10333 E 21ST ST N STE 204
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3545
Practice Address - Country:US
Practice Address - Phone:316-630-8444
Practice Address - Fax:316-630-8449
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-58645-071163WP0807X
KS74833163WP0807X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMW0714940OtherDEA LICENSE #
Q14877Medicare UPIN
070197Medicare ID - Type Unspecified