Provider Demographics
NPI:1629796263
Name:ROUTZEN, KAITLYN SIERRA (CNM, WH-NP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:SIERRA
Last Name:ROUTZEN
Suffix:
Gender:F
Credentials:CNM, WH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LA CASA VIA STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3059
Mailing Address - Country:US
Mailing Address - Phone:925-239-0012
Mailing Address - Fax:
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-939-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022189363LW0102X
CA4780364S00000X
CA236286367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist