Healthcare Provider Details

I. General information

NPI: 1932102472
Provider Name (Legal Business Name): KURT SANDERS CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 E REGAL DR
SUN LAKES AZ
85248-7918
US

IV. Provider business mailing address

PO BOX 6555
SCOTTSDALE AZ
85261-6555
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-3125
  • Fax: 480-947-4543
Mailing address:
  • Phone: 480-945-3125
  • Fax: 480-947-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN063926
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: