Healthcare Provider Details

I. General information

NPI: 1881225001
Provider Name (Legal Business Name): NEECHELLE JANE'E HURN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8920 EMERALD PARK DR STE G
ELK GROVE CA
95624-2380
US

IV. Provider business mailing address

8920 EMERALD PARK DR STE G
ELK GROVE CA
95624-2380
US

V. Phone/Fax

Practice location:
  • Phone: 916-544-0502
  • Fax: 916-688-8603
Mailing address:
  • Phone: 916-544-0502
  • Fax: 916-688-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number80172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: