Provider Demographics
NPI:1134359789
Name:EHRENREICH, KYLA WOLFF (PA-C)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:WOLFF
Last Name:EHRENREICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:WOLFF
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7570
Practice Address - Street 1:WEST COUNTY HEALTH CENTERS
Practice Address - Street 2:652 PETALUMA AVE SUITE H
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20387363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant