Healthcare Provider Details

I. General information

NPI: 1467541516
Provider Name (Legal Business Name): CHERYL E HURLBURT APRN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HERMITAGE CT
PEARL RIVER LA
70452-3903
US

IV. Provider business mailing address

507 HERMITAGE CT
PEARL RIVER LA
70452-3903
US

V. Phone/Fax

Practice location:
  • Phone: 985-863-2828
  • Fax:
Mailing address:
  • Phone: 985-863-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN58600AP3134
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: