Provider Demographics
NPI:1780889980
Name:DITZ, KIMBERLY ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:DITZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:18 CAM- HAY DRIVE
Mailing Address - City:LEWIS RUN
Mailing Address - State:PA
Mailing Address - Zip Code:16738-0151
Mailing Address - Country:US
Mailing Address - Phone:814-362-6565
Mailing Address - Fax:814-362-6415
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3278
Practice Address - Country:US
Practice Address - Phone:814-362-5250
Practice Address - Fax:814-362-2185
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP009420363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health