Healthcare Provider Details

I. General information

NPI: 1619475035
Provider Name (Legal Business Name): RACHELLE ANNE HURLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # N212
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST # N212
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-323-5956
  • Fax: 859-323-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3012034
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: