MEDICARE: ANGELYNN KITZEROW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	201607732NP-PP	OR

General Provider Information

NPI Number	:	1629528278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELYNN KITZEROW

Provider Business Mailing Address
First Line	:	3181 SW SAM JACKSON PARK RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3011
Country	:	US
Telephone Number	:	312-933-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1287B ARGUELLO BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-2755
Country	:	US
Telephone Number	:	312-933-4488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2016
Last Update Date	:	12/06/2016

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Directions to “ ANGELYNN KITZEROW ” Practice Location

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