Healthcare Provider Details

I. General information

NPI: 1255706370
Provider Name (Legal Business Name): ALISHA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20514 STANSBURY ST
DETROIT MI
48235-1596
US

IV. Provider business mailing address

20514 STANSBURY ST
DETROIT MI
48235-1596
US

V. Phone/Fax

Practice location:
  • Phone: 313-704-8211
  • Fax:
Mailing address:
  • Phone: 313-704-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703115364
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: