Healthcare Provider Details

I. General information

NPI: 1669061552
Provider Name (Legal Business Name): ALFRED HURST RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6162 S WILLOW DR
GREENWOOD VILLAGE CO
80111-5113
US

IV. Provider business mailing address

6162 S WILLOW DR
GREENWOOD VILLAGE CO
80111-5113
US

V. Phone/Fax

Practice location:
  • Phone: 303-220-9200
  • Fax:
Mailing address:
  • Phone: 303-220-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1654473
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: