Provider Demographics
NPI:1033321963
Name:KRIZ, NICHOL ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICHOL
Middle Name:ANN
Last Name:KRIZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8865 SERRANO WAY
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-9623
Mailing Address - Country:US
Mailing Address - Phone:707-277-0661
Mailing Address - Fax:
Practice Address - Street 1:5176 HILL ROAD EAST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-6111
Practice Address - Country:US
Practice Address - Phone:707-262-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13422363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ32234Medicare UPIN