Healthcare Provider Details

I. General information

NPI: 1972692663
Provider Name (Legal Business Name): KIM HURTIG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 21ST AVE
ROCK VALLEY IA
51247-1420
US

IV. Provider business mailing address

1315 8TH ST
HULL IA
51239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 712-476-8000
  • Fax: 712-476-8090
Mailing address:
  • Phone: 712-439-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberDO70350
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: