Healthcare Provider Details

I. General information

NPI: 1114950193
Provider Name (Legal Business Name): BRENDA JOYCE HURTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA JOYCE MARKLEY

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 1ST ST NE
FARIBAULT MN
55021-5441
US

IV. Provider business mailing address

924 1ST ST NE
FARIBAULT MN
55021-5441
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-3300
  • Fax: 507-333-3214
Mailing address:
  • Phone: 507-333-3300
  • Fax: 507-333-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38208
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: