Healthcare Provider Details

I. General information

NPI: 1295984359
Provider Name (Legal Business Name): MICHELE Y. HURSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 CLEVELAND AVE
STEVENSVILLE MI
49127-9595
US

IV. Provider business mailing address

69405 CHRISTIANA LAKE ROAD
EDWARDSBURG MI
49112
US

V. Phone/Fax

Practice location:
  • Phone: 270-983-6501
  • Fax: 269-983-2237
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704255526
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: