Provider Demographics
NPI:1699092148
Name:KURTENBACH, JESSE (CRNA)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:KURTENBACH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6365
Mailing Address - Country:US
Mailing Address - Phone:605-338-7098
Mailing Address - Fax:605-335-3505
Practice Address - Street 1:1100 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4046
Practice Address - Country:US
Practice Address - Phone:605-338-7098
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000745367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered