MEDICARE: MRS. ANDRA L KURTZ NP-C

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	363LF0000X	Family Nurse Practitioner	COA14592-NP	OH

General Provider Information

NPI Number	:	1336589902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDRA L KURTZ NP-C

Provider Business Mailing Address
First Line	:	1019 PIERCE ST
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4633
Country	:	US
Telephone Number	:	419-626-1118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 PIERCE ST
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4633
Country	:	US
Telephone Number	:	419-626-1118
Fax Number	:

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

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	06/27/2013

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