Provider Demographics
NPI:1295181071
Name:WIJDENES, KATI (DNP)
Entity type:Individual
Prefix:DR
First Name:KATI
Middle Name:
Last Name:WIJDENES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 E UNIVERSITY DR UNIT 31505
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-0270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1530 E WILLIAMS FIELD RD STE 201-9
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1823
Practice Address - Country:US
Practice Address - Phone:480-418-0184
Practice Address - Fax:480-602-5656
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG175516363LP0808X
AZAP8449363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health