Healthcare Provider Details

I. General information

NPI: 1295564706
Provider Name (Legal Business Name): DANIELLE KURTZ DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 RANDALL PKWY
WILMINGTON NC
28403-2829
US

IV. Provider business mailing address

5010 RANDALL PKWY
WILMINGTON NC
28403-2829
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-5719
  • Fax:
Mailing address:
  • Phone: 910-791-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020493
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: