Provider Demographics
NPI:1184180002
Name:VANTZELFDEN, KIRSTEN (CRM)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:
Last Name:VANTZELFDEN
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 NE 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4268
Mailing Address - Country:US
Mailing Address - Phone:541-306-4446
Mailing Address - Fax:541-550-2011
Practice Address - Street 1:1435 NE 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4268
Practice Address - Country:US
Practice Address - Phone:541-306-4446
Practice Address - Fax:541-550-2011
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19-CRM-043175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist