Basic Information
Provider Information
NPI: 1508878133
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BELZER
FirstName: KATHLEEN
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 255228
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958655228
CountryCode: US
TelephoneNumber: 8004700071
FaxNumber:  
Practice Location
Address1: 2020 SUTTER PL
Address2: SUITE 203
City: DAVIS
State: CA
PostalCode: 956166213
CountryCode: US
TelephoneNumber: 5307505880
FaxNumber: 5307505881
Other Information
ProviderEnumerationDate: 08/12/2006
LastUpdateDate: 01/03/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XNM1062CAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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