Healthcare Provider Details

I. General information

NPI: 1174295026
Provider Name (Legal Business Name): RAMONA HURSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 W DANIEL ST
CHAMPAIGN IL
61821-4054
US

IV. Provider business mailing address

2011 MORELAND BLVD UNIT 205
CHAMPAIGN IL
61822-1435
US

V. Phone/Fax

Practice location:
  • Phone: 217-390-1794
  • Fax:
Mailing address:
  • Phone: 217-390-1794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: