Provider Demographics
NPI:1396845517
Name:KURTZ, COLLEEN M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:KURTZ
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6932 WILLIAMS RD
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3071
Mailing Address - Country:US
Mailing Address - Phone:716-297-7040
Mailing Address - Fax:716-297-7048
Practice Address - Street 1:6932 WILLIAMS RD
Practice Address - Street 2:SUITE 1700
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3071
Practice Address - Country:US
Practice Address - Phone:716-297-7040
Practice Address - Fax:716-297-7048
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006030-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS77865Medicare UPIN
NYPA1236Medicare ID - Type Unspecified