Provider Demographics
NPI:1457907123
Name:DIPPEL, KATHRYN SCHULTZ (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SCHULTZ
Last Name:DIPPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:KATHRYN
Other - Middle Name:OLSON
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2217 VANDERBILT LN UNIT 6
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3156
Mailing Address - Country:US
Mailing Address - Phone:707-696-4478
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012504363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care