Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP61016241 | WA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | TBD | WA |
NPI | 1174170724 |
---|---|
Provider Name | Jennifer Louise Kurtz |
First Address | Puyallup, WA 98372-4476 |
Second Address | Tacoma, WA 98405-4234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2019 |
Last Update Date | 11/12/2019 |