Healthcare Provider Details

I. General information

NPI: 1629796263
Provider Name (Legal Business Name): KAITLYN SIERRA ROUTZEN CNM, WH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LA CASA VIA
WALNUT CREEK CA
94598-3091
US

IV. Provider business mailing address

112 LA CASA VIA STE 300
WALNUT CREEK CA
94598-3059
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-3000
  • Fax:
Mailing address:
  • Phone: 925-239-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95022189
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4780
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: