Healthcare Provider Details

I. General information

NPI: 1164708129
Provider Name (Legal Business Name): KRISTI HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17909 BURKE ST
OMAHA NE
68118-2252
US

IV. Provider business mailing address

17909 BURKE ST
OMAHA NE
68118-2252
US

V. Phone/Fax

Practice location:
  • Phone: 402-289-0808
  • Fax:
Mailing address:
  • Phone: 402-289-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12388
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: