Healthcare Provider Details

I. General information

NPI: 1538811500
Provider Name (Legal Business Name): JENNIFER KURTZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NIAGARA ST
BUFFALO NY
14213-2001
US

IV. Provider business mailing address

72 CUNARD AVE
CHEEKTOWAGA NY
14225-5007
US

V. Phone/Fax

Practice location:
  • Phone: 716-768-7600
  • Fax:
Mailing address:
  • Phone: 716-783-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number721470
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number34849
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: