Basic Information
| Provider Information | |||||||||
| NPI: | 1790884799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KURZWEG | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8681 EAGLE POINT BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKE ELMO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550428628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512518021 | ||||||||
| FaxNumber: | 6512518050 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 SMITH ST N | ||||||||
| Address2: | |||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517350501 | ||||||||
| FaxNumber: | 6517351870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R1383577 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 215809400 | 05 | MN | MEDICAID |