Provider Demographics
NPI:1104432988
Name:KURTZ, ESPERANZA MICAELA
Entity type:Individual
Prefix:MRS
First Name:ESPERANZA
Middle Name:MICAELA
Last Name:KURTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-9426
Mailing Address - Country:US
Mailing Address - Phone:330-993-0567
Mailing Address - Fax:
Practice Address - Street 1:3575 W RIVER RD
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-9426
Practice Address - Country:US
Practice Address - Phone:330-993-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X, 374U00000X, 376J00000X
OH00002732773747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000273277OtherSTATE OF OHIO D.O.D.D.
OH0413324Medicaid