Provider Demographics
NPI:1417217746
Name:KURZ, ANDREA RENEE
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:RENEE
Last Name:KURZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:RENEE
Other - Last Name:PENDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 SHADOW LANE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4194
Mailing Address - Country:US
Mailing Address - Phone:702-388-4512
Mailing Address - Fax:702-388-8431
Practice Address - Street 1:620 SHADOW LANE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4194
Practice Address - Country:US
Practice Address - Phone:702-388-4512
Practice Address - Fax:702-388-8431
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine