Provider Demographics
NPI:1235817826
Name:KITZEROW, EMILY MILLS (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MILLS
Last Name:KITZEROW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7750
Mailing Address - Fax:707-573-5427
Practice Address - Street 1:3883 AIRWAY DR STE 320
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1671
Practice Address - Country:US
Practice Address - Phone:707-521-7750
Practice Address - Fax:707-573-5427
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily