Healthcare Provider Details

I. General information

NPI: 1326328048
Provider Name (Legal Business Name): LAURA JEAN HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E 15TH ST
NEW ALBANY IN
47150-3102
US

IV. Provider business mailing address

909 E 15TH ST
NEW ALBANY IN
47150-3102
US

V. Phone/Fax

Practice location:
  • Phone: 502-794-1704
  • Fax:
Mailing address:
  • Phone: 502-794-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: