Provider Demographics
NPI:1831297324
Name:KITZMAN, MARILYN A (FNP, PA-C)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
Last Name:KITZMAN
Suffix:
Gender:F
Credentials:FNP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1645
Mailing Address - Country:US
Mailing Address - Phone:701-776-5235
Mailing Address - Fax:701-776-5297
Practice Address - Street 1:800 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1645
Practice Address - Country:US
Practice Address - Phone:701-776-5235
Practice Address - Fax:701-776-5297
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0050363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN4688OtherBLUE SHIELD
NDN4688OtherBLUE SHIELD