1639347420 NPI number — SANDRA DENISE KURTYKA MSN CRNP

Table of content: SANDRA DENISE KURTYKA MSN CRNP (NPI 1639347420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639347420 NPI number — SANDRA DENISE KURTYKA MSN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURTYKA
Provider First Name:
SANDRA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREENE
Provider Other First Name:
SANDRA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN C.R.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639347420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 ARRANDALE BLVD
Provider Second Line Business Mailing Address:
CHESTER COUNTY PEDIATRICS
Provider Business Mailing Address City Name:
EXTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-524-5437
Provider Business Mailing Address Fax Number:
610-524-5645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 ARRANDALE BLVD
Provider Second Line Business Practice Location Address:
CHESTER COUNTY PEDIATRICS
Provider Business Practice Location Address City Name:
EXTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-524-5437
Provider Business Practice Location Address Fax Number:
610-524-5645
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP009553 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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