Healthcare Provider Details

I. General information

NPI: 1215578711
Provider Name (Legal Business Name): PATSY E HURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 10/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21659A SONGBIRD DR
CHUGIAK AK
99567-5615
US

IV. Provider business mailing address

21659A SONGBIRD DR
CHUGIAK AK
99567-5615
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-1000
  • Fax: 888-588-5194
Mailing address:
  • Phone: 907-373-1000
  • Fax: 888-588-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number12345
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: