Healthcare Provider Details

I. General information

NPI: 1871014563
Provider Name (Legal Business Name): CORALYN JOY JENSEN KURTZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORALYN JOY JENSEN, WEBER

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 25TH ST S
FARGO ND
58103-6104
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax:
Mailing address:
  • Phone: 605-328-9419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR39287
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: