Provider Demographics
NPI:1396042933
Name:PORTER, KURT (CRNA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8393 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-8042
Mailing Address - Country:US
Mailing Address - Phone:301-580-3768
Mailing Address - Fax:
Practice Address - Street 1:8393 CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-8042
Practice Address - Country:US
Practice Address - Phone:301-580-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992576-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered