Healthcare Provider Details

I. General information

NPI: 1427225457
Provider Name (Legal Business Name): JENNIFER MARY HURLBUTT CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 TONGASS AVE STE 207
KETCHIKAN AK
99901-6072
US

IV. Provider business mailing address

1621 TONGASS AVE SUITE 207
KETCHIKAN AK
99901-6013
US

V. Phone/Fax

Practice location:
  • Phone: 907-220-9447
  • Fax: 907-220-9884
Mailing address:
  • Phone: 907-220-9447
  • Fax: 907-220-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1202
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: