Healthcare Provider Details

I. General information

NPI: 1982858411
Provider Name (Legal Business Name): JOYCE ANN HURT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 ECKERMAN RD
ROSEVILLE CA
95661-5911
US

IV. Provider business mailing address

9380 ECKERMAN RD
ROSEVILLE CA
95661-5911
US

V. Phone/Fax

Practice location:
  • Phone: 916-791-9011
  • Fax: 916-791-9011
Mailing address:
  • Phone: 916-791-9011
  • Fax: 916-791-9011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number657758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: