Provider Demographics
NPI:1740554799
Name:KURTZWORTH, LANALYNNE ANN (RN)
Entity type:Individual
Prefix:
First Name:LANALYNNE
Middle Name:ANN
Last Name:KURTZWORTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BERANDA CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-4626
Mailing Address - Country:US
Mailing Address - Phone:770-885-5612
Mailing Address - Fax:
Practice Address - Street 1:35 BERANDA CIR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-4626
Practice Address - Country:US
Practice Address - Phone:770-885-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108638163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent