Provider Demographics
NPI:1427864404
Name:KITZMAN, KYLEEN
Entity type:Individual
Prefix:
First Name:KYLEEN
Middle Name:
Last Name:KITZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 5TH ST W STE 1
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1204
Mailing Address - Country:US
Mailing Address - Phone:701-537-5944
Mailing Address - Fax:701-537-5417
Practice Address - Street 1:314 5TH ST W STE 1
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1204
Practice Address - Country:US
Practice Address - Phone:701-537-5944
Practice Address - Fax:701-537-5417
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator