Healthcare Provider Details

I. General information

NPI: 1417001769
Provider Name (Legal Business Name): ANGELA MARIE HURLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CHARLES RIVER PLAZA SUITE 404
BOSTON MA
02114
US

IV. Provider business mailing address

66 BRADSTREET RD
NORTH ANDOVER MA
01845-3936
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-9470
  • Fax:
Mailing address:
  • Phone: 978-683-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2006005563
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: