Provider Demographics
NPI:1770292203
Name:KITTLE, MARIE LOUISE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:KITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:HOIEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 CROWN POINT CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9530
Mailing Address - Country:US
Mailing Address - Phone:520-205-6994
Mailing Address - Fax:
Practice Address - Street 1:345 CROWN POINT CIR STE 300
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9530
Practice Address - Country:US
Practice Address - Phone:520-205-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker