Basic Information
| Provider Information | |||||||||
| NPI: | 1417217746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURZ | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PENDLETON | ||||||||
| OtherFirstName: | ANDREA | ||||||||
| OtherMiddleName: | RENEE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 620 SHADOW LANE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023884512 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 SHADOW LANE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023884512 | ||||||||
| FaxNumber: | 7023888431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2012 | ||||||||
| LastUpdateDate: | 05/21/2012 | ||||||||
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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 | 207Q00000X | SL0881 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.