Provider Demographics
NPI:1851999262
Name:KRATZ, SHAWN L
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:L
Last Name:KRATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHAPEL PLAZA CT STE 11
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6398
Mailing Address - Country:US
Mailing Address - Phone:573-445-6340
Mailing Address - Fax:
Practice Address - Street 1:2011 CHAPEL PLAZA CT STE 11
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6398
Practice Address - Country:US
Practice Address - Phone:573-445-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide