Healthcare Provider Details

I. General information

NPI: 1134723893
Provider Name (Legal Business Name): DEBORAH CHRISTINE HURLBUT LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 D ST
MARYSVILLE CA
95901-5952
US

IV. Provider business mailing address

528 HARRIS ST
MARYSVILLE CA
95901-4425
US

V. Phone/Fax

Practice location:
  • Phone: 818-206-0360
  • Fax:
Mailing address:
  • Phone: 530-635-7942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number205464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: