Healthcare Provider Details

I. General information

NPI: 1003057688
Provider Name (Legal Business Name): TRINA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-2923
US

IV. Provider business mailing address

11907 WAPITI WAY
NOBLESVILLE IN
46060-7912
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1037
  • Fax: 866-785-4924
Mailing address:
  • Phone: 574-309-6480
  • Fax: 866-785-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004747A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: