Healthcare Provider Details

I. General information

NPI: 1508470592
Provider Name (Legal Business Name): HALLIE KURTZ DNP, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/26/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7530 164TH AVE. NE SUITE A215
REDMOND WA
98052-7809
US

IV. Provider business mailing address

7530 164TH AVE. NE SUITE A215
REDMOND WA
98052-7809
US

V. Phone/Fax

Practice location:
  • Phone: 425-855-9292
  • Fax:
Mailing address:
  • Phone: 425-855-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60810527
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61448112
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: