Provider Demographics
NPI:1518678564
Name:WURLITZER, KRISTA NOELLE (LM, CPM)
Entity Type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:NOELLE
Last Name:WURLITZER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0316
Mailing Address - Country:US
Mailing Address - Phone:530-680-2727
Mailing Address - Fax:530-605-2725
Practice Address - Street 1:845 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0316
Practice Address - Country:US
Practice Address - Phone:530-680-2727
Practice Address - Fax:530-605-2725
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM695176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALM695OtherLICENSE NUMBER