| Doctor Name: | KATHLEEN ANNE WIRTZ |
| NPI Number: | 1801100201 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP60184972 |
| Business Practice Address: | 211 Cunningham Rd Kelso, WA - 986269611 |
| Business Phone Number: | 3607490010 |
| Business Fax Number: | 3604250861 |
| Mailing Address: | Po Box 48, CARROLLS |
| State: | WA |
| Postal Code: | 986090048 |
| Phone Number: | 3607490010 |
| Fax Number: | 3604250861 |
| NPI Enumeration Date: | 07/28/2010 |
| NPI Last Update Date: | 04/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | AP60184972 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |