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General NPI Number Information
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NPI Number | 1073278776
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Entity Type | Individual
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Provider Name | MADELINE MARTIN KURTZ
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Gender | Female
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 2344 HELEN ST N
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City | NORTH SAINT PAUL
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State | MN
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Zip | 55109-2942
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Country | US
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Telephone | 651-773-5988
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 SOUTHCROSS DR W
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City | BURNSVILLE
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State | MN
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Zip | 55306-6945
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Country | US
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Telephone | 952-491-9810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 202668
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 202668
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License Number State | MN
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