Healthcare Provider Details

I. General information

NPI: 1780391813
Provider Name (Legal Business Name): MICHA M HURLEY CPM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 W PEROLA DR
PHOENIX AZ
85085-7157
US

IV. Provider business mailing address

5622 W PALMAIRE AVE
GLENDALE AZ
85301-2510
US

V. Phone/Fax

Practice location:
  • Phone: 404-519-6316
  • Fax:
Mailing address:
  • Phone: 623-748-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM257
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: