Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 201607732NP-PP | OR |
NPI | 1629528278 |
---|---|
Provider Name | Angelynn Kitzerow |
First Address | Portland, OR 97239-3011 |
Second Address | San Francisco, CA 94122-2755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2016 |
Last Update Date | 06/12/2016 |