Healthcare Provider Details

I. General information

NPI: 1093493819
Provider Name (Legal Business Name): MRS. CLAUDIA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N DENENE ST
WICHITA KS
67212-4384
US

IV. Provider business mailing address

1111 N DENENE ST
WICHITA KS
67212-4384
US

V. Phone/Fax

Practice location:
  • Phone: 316-889-1819
  • Fax: 316-469-0846
Mailing address:
  • Phone: 316-889-1819
  • Fax: 316-469-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number111514
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number111514
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: