Provider Demographics
NPI:1245674498
Name:KRUTZ, ADRIAN MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MARIE
Last Name:KRUTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 COLUMBIA PIKE
Mailing Address - Street 2:#202
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-4451
Mailing Address - Country:US
Mailing Address - Phone:978-602-5648
Mailing Address - Fax:
Practice Address - Street 1:8716 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-2531
Practice Address - Country:US
Practice Address - Phone:360-514-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170826363LF0000X
WAAP60790751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily