Healthcare Provider Details

I. General information

NPI: 1205546918
Provider Name (Legal Business Name): AMY LYNN KURITZ APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 FOURIER DR STE 200
MADISON WI
53717-1958
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
NEW BRIGHTON MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 608-740-2001
  • Fax:
Mailing address:
  • Phone: 651-379-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13208
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: