Healthcare Provider Details

I. General information

NPI: 1003543174
Provider Name (Legal Business Name): MRS. INES HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 BEAUBIEN ST
DETROIT MI
48201-2166
US

IV. Provider business mailing address

3950 BEAUBIEN ST
DETROIT MI
48201-2166
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5437
  • Fax:
Mailing address:
  • Phone: 313-745-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704327597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: