Provider Demographics
NPI:1801160114
Name:KURTZ, KRISTINA MARIE
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MARIE
Last Name:KURTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6784 BOOTMAKER WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:WI
Mailing Address - Zip Code:53598-9630
Mailing Address - Country:US
Mailing Address - Phone:608-778-1653
Mailing Address - Fax:
Practice Address - Street 1:6784 BOOTMAKER WAY
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:WI
Practice Address - Zip Code:53598-9630
Practice Address - Country:US
Practice Address - Phone:608-778-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWISREN004911277164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse