Healthcare Provider Details

I. General information

NPI: 1841861556
Provider Name (Legal Business Name): ASHLEY LYNN HURLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 6TH ST
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

5463 LONE BEECH DR
TRAVERSE CITY MI
49685-7383
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704315437
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: