Basic Information
| Provider Information | |||||||||
| NPI: | 1659696623 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURTZ | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154265950 | ||||||||
| FaxNumber: | 3154265995 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154265950 | ||||||||
| FaxNumber: | 3154265995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 04/02/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 561463-1 | NY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.