Provider Demographics
NPI:1669549762
Name:KITZEROW, REBECCA MAYRE HURWOOD (LAC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MAYRE HURWOOD
Last Name:KITZEROW
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:MAYRE
Other - Last Name:HURWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:419 E CEDAR AVE STE A205
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-5482
Mailing Address - Country:US
Mailing Address - Phone:360-952-3074
Mailing Address - Fax:360-952-3074
Practice Address - Street 1:419 E CEDAR AVE STE A205
Practice Address - Street 2:
Practice Address - City:LA CENTER
Practice Address - State:WA
Practice Address - Zip Code:98629-5482
Practice Address - Country:US
Practice Address - Phone:360-952-3074
Practice Address - Fax:360-952-3074
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01021171100000X
WAAC60689953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist