Provider Demographics
NPI:1790062479
Name:MITTS, KATHRYN (RN, CDE)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MITTS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:WELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:365 TESCONI CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4617
Mailing Address - Country:US
Mailing Address - Phone:707-575-6043
Mailing Address - Fax:707-575-1060
Practice Address - Street 1:365 TESCONI CIR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4617
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:707-575-1060
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609840163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator