MEDICARE: CHRISTINA LEE HURST FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F0616550	OH
2	363L00000X	Nurse Practitioner	APRN.CNP.019338	OH

General Provider Information

NPI Number	:	1447705132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA LEE HURST FNP-C

Provider Business Mailing Address
First Line	:	400 N MARKET ST
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1014
Country	:	US
Telephone Number	:	330-424-9866
Fax Number	:	330-424-7689

Provider Business Practice Location Address
First Line	:	400 N MARKET ST
Second Line	:
City	:	LISBON
State	:	OH
Zip	:	44432-1014
Country	:	US
Telephone Number	:	330-424-9866
Fax Number	:	330-424-7689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	05/08/2020

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