Basic Information
| Provider Information | |||||||||
| NPI: | 1073556924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGUIRE | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 N SWAN RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203242030 | ||||||||
| FaxNumber: | 5204456019 | ||||||||
| Practice Location | |||||||||
| Address1: | 2810 N SWAN RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857126300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203242030 | ||||||||
| FaxNumber: | 5204456019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 53090 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 009934624 | 05 | AL | MEDICAID |