Provider Demographics
NPI:1689864795
Name:NITZSCHE, KRISTINA P (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:P
Last Name:NITZSCHE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-672-8643
Mailing Address - Fax:231-672-8651
Practice Address - Street 1:1560 E SHERMAN BLVD STE 309
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1850
Practice Address - Country:US
Practice Address - Phone:231-672-8643
Practice Address - Fax:231-672-8651
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004981363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN94150010OtherMEDICARE PTAN