Healthcare Provider Details

I. General information

NPI: 1174170724
Provider Name (Legal Business Name): JENNIFER LOUISE KURTZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

IV. Provider business mailing address

15312 88TH ST E
PUYALLUP WA
98372-4476
US

V. Phone/Fax

Practice location:
  • Phone: 253-404-1024
  • Fax:
Mailing address:
  • Phone: 253-307-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP61016241
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberTBD
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: