Provider Demographics
NPI:1457894867
Name:ANDREA KURTZ ACUPUNCTURIST AND CHINESE HERBALIST, PS, INC
Entity Type:Organization
Organization Name:ANDREA KURTZ ACUPUNCTURIST AND CHINESE HERBALIST, PS, INC
Other - Org Name:SOUND VIEW ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:EAMP
Authorized Official - Phone:206-200-3595
Mailing Address - Street 1:3206 46TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3333
Mailing Address - Country:US
Mailing Address - Phone:206-200-3595
Mailing Address - Fax:
Practice Address - Street 1:5410 CALIFORNIA AVE SW
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98136-1562
Practice Address - Country:US
Practice Address - Phone:206-200-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty