Basic Information
| Provider Information | |||||||||
| NPI: | 1336344514 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCBRIDE | ||||||||
| FirstName: | KATHLEEN | ||||||||
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| Credential: | CRNA, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1370 | ||||||||
| Address2: | |||||||||
| City: | HEREFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856151370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203782590 | ||||||||
| FaxNumber: | 5203784024 | ||||||||
| Practice Location | |||||||||
| Address1: | 6644 E BAYWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803212000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN039208 CRNA0039 | AZ | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 363LF0000X | RN039208 AP0867 | AZ | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.