Healthcare Provider Details

I. General information

NPI: 1912367145
Provider Name (Legal Business Name): ANDREA BETH KURKUL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CAMBRIDGE ST 5TH FLOOR
BOSTON MA
02114
US

IV. Provider business mailing address

165 CAMBRIDGE ST 5TH FLOOR
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-4600
  • Fax: 617-228-6306
Mailing address:
  • Phone: 617-726-4600
  • Fax: 617-228-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number690028
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR17964000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2292721
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1019717
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308106
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2292721
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: