Healthcare Provider Details

I. General information

NPI: 1659812782
Provider Name (Legal Business Name): MS. SHIRLEY ANN HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 N RIDGE BLVD APT 2 APT 2
CHICAGO IL
60645-4916
US

IV. Provider business mailing address

6817 N RIDGE BLVD APT 2
CHICAGO IL
60645-4916
US

V. Phone/Fax

Practice location:
  • Phone: 773-962-8538
  • Fax:
Mailing address:
  • Phone: 773-962-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH64078060753
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: