Provider Demographics
NPI:1003999160
Name:WIRTH, KATHERINE E (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:WIRTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2205
Mailing Address - Country:US
Mailing Address - Phone:239-332-9501
Mailing Address - Fax:
Practice Address - Street 1:3920 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-2205
Practice Address - Country:US
Practice Address - Phone:239-332-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9215517363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307164200Medicaid
FLU8894ZMedicare PIN