Provider Demographics
NPI:1700640752
Name:KAUTZ, MARISA ANGELENE (FNP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANGELENE
Last Name:KAUTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN STE A170
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6673
Mailing Address - Country:US
Mailing Address - Phone:209-477-5552
Mailing Address - Fax:209-477-5553
Practice Address - Street 1:1801 E MARCH LN STE A170
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6673
Practice Address - Country:US
Practice Address - Phone:209-477-5552
Practice Address - Fax:209-477-5553
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95029291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily