Healthcare Provider Details

I. General information

NPI: 1063502466
Provider Name (Legal Business Name): KATHLEEN BROOKS HURLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 HORNBEAM DR
ROCKVILLE MD
20853-1416
US

IV. Provider business mailing address

4509 HORNBEAM DR
ROCKVILLE MD
20853-1416
US

V. Phone/Fax

Practice location:
  • Phone: 301-461-0953
  • Fax: 301-924-0131
Mailing address:
  • Phone: 301-461-0953
  • Fax: 301-924-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR097897
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: