Healthcare Provider Details

I. General information

NPI: 1104447135
Provider Name (Legal Business Name): KIRSTEN LAREE PLATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ACADEMY AVE
DANVILLE PA
17822-5002
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-5002
US

V. Phone/Fax

Practice location:
  • Phone: 570-214-9018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: