Basic Information
| Provider Information | |||||||||
| NPI: | 1457883043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURLAND | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E VENANGO ST APT 120 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191342735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737586008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 S 8TH ST STE 2L | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673227700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2017 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0047258 | DE | N | Nursing Service Providers | Registered Nurse | 163W00000X | 26NR17947900 | NJ | N | Nursing Service Providers | Registered Nurse | 367500000X | RN670577 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | RN670577 | PA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.