Healthcare Provider Details

I. General information

NPI: 1902782006
Provider Name (Legal Business Name): MADELYN HURLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELYN THICH

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAPLE ST FL 4
REDWOOD CITY CA
94063-2057
US

IV. Provider business mailing address

408 42ND AVE
SAN MATEO CA
94403-5006
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-4895
  • Fax:
Mailing address:
  • Phone: 207-590-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number827227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: