Healthcare Provider Details

I. General information

NPI: 1912066051
Provider Name (Legal Business Name): LOU ANN HURST CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 01/04/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELLNESS WAY
MILFORD DE
19963-4364
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7088
  • Fax: 302-744-6407
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN501635L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberL1-0041992
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: