MEDICARE: KRISTIN CURTIS CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant	165144	IN

General Provider Information

NPI Number	:	1295275337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN CURTIS CSFA

Provider Business Mailing Address
First Line	:	103 TAYLORS WAY
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9223
Country	:	US
Telephone Number	:	574-261-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 TAYLORS WAY
Second Line	:
City	:	NORTH LIBERTY
State	:	IN
Zip	:	46554-9223
Country	:	US
Telephone Number	:	574-261-8289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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