Healthcare Provider Details

I. General information

NPI: 1578982435
Provider Name (Legal Business Name): SHEILAH MAUREEN KRAETZEL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TERRACE
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

1530 E. CHEVY CHASE DRIVE
GLENDALE CA
91206-4163
US

V. Phone/Fax

Practice location:
  • Phone: 818-243-0514
  • Fax:
Mailing address:
  • Phone: 818-243-0514
  • Fax: 818-243-7518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20091
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20091
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20091
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number20091
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number20091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: