Provider Demographics
NPI:1588873087
Name:GOLTERMANN, KURTIS (CRNA)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:
Last Name:GOLTERMANN
Suffix:
Gender:
Credentials:CRNA
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Other - Credentials:
Mailing Address - Street 1:35 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:NY
Mailing Address - Zip Code:14464-9322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3011
Practice Address - Country:US
Practice Address - Phone:585-922-4159
Practice Address - Fax:585-922-3731
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY532787-1163W00000X
NY079022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB7210OtherMEDICARE UPIN/PTAN