Provider Demographics
NPI:1902531502
Name:KURTZ, DAPHNE D (NP)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:D
Last Name:KURTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DAPHNE
Other - Middle Name:D
Other - Last Name:REYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:425 COLLEGE DR S
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 COLLEGE DR S
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3537
Practice Address - Country:US
Practice Address - Phone:701-662-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32424363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health