Provider Demographics
NPI:1912367145
Name:KURKUL, ANDREA BETH (CNP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:BETH
Last Name:KURKUL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:165 CAMBRIDGE ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-4600
Mailing Address - Fax:617-228-6306
Practice Address - Street 1:165 CAMBRIDGE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-4600
Practice Address - Fax:617-228-6306
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690028163W00000X
NJ26NR17964000163W00000X
MARN2292721163W00000X, 363L00000X
DCRN1019717163W00000X
NYF308106363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health