Healthcare Provider Details

I. General information

NPI: 1508263047
Provider Name (Legal Business Name): TRACY HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19920 BARCHESTER DR
MACOMB MI
48044-1786
US

IV. Provider business mailing address

19920 BARCHESTER DR
MACOMB MI
48044-1786
US

V. Phone/Fax

Practice location:
  • Phone: 586-265-0000
  • Fax:
Mailing address:
  • Phone: 586-265-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: