Provider Demographics
NPI:1225000144
Name:KRATZ, MARY H (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:H
Last Name:KRATZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 EVELYN BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7608
Mailing Address - Country:US
Mailing Address - Phone:540-434-3831
Mailing Address - Fax:
Practice Address - Street 1:2291 EVELYN BYRD AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5424
Practice Address - Country:US
Practice Address - Phone:540-434-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52392363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO61638765Medicaid
CO402088Medicare ID - Type Unspecified
CO61638765Medicaid