Healthcare Provider Details

I. General information

NPI: 1205962818
Provider Name (Legal Business Name): ELIZABETH ANN HURLEY C.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 CASTRO VALLEY BLVD SUITE B
CASTRO VALLEY CA
94546-4400
US

IV. Provider business mailing address

5 RIVER ROCK RD
SHERIDAN WY
82801-9033
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-6915
  • Fax: 866-535-0635
Mailing address:
  • Phone: 307-752-6915
  • Fax: 866-535-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number324
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: