Healthcare Provider Details

I. General information

NPI: 1205373347
Provider Name (Legal Business Name): TERRONDA HURN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 W 24TH AVE
GARY IN
46406-2821
US

IV. Provider business mailing address

4747 W 24TH AVE
GARY IN
46406-2821
US

V. Phone/Fax

Practice location:
  • Phone: 219-240-8615
  • Fax: 219-977-1197
Mailing address:
  • Phone: 219-240-8615
  • Fax: 219-977-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28219557A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: