Healthcare Provider Details

I. General information

NPI: 1598357642
Provider Name (Legal Business Name): KENDRALIA MARSHA KRETZSCHMAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDRALIA MARSHA AGAZIE

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 W ANKLAM RD STE 108
TUCSON AZ
85745-2656
US

IV. Provider business mailing address

9401 W THUNDERBIRD RD STE 180
PEORIA AZ
85381-4210
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-516-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number339706
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: