Healthcare Provider Details

I. General information

NPI: 1396209433
Provider Name (Legal Business Name): MEGAN LOUISE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 ALDUN RIDGE AVE NW APT 101
COMSTOCK PARK MI
49321-9028
US

IV. Provider business mailing address

4645 ALDUN RIDGE AVE NW APT 101
COMSTOCK PARK MI
49321-9028
US

V. Phone/Fax

Practice location:
  • Phone: 616-724-7273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5302044635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: