Healthcare Provider Details

I. General information

NPI: 1629365788
Provider Name (Legal Business Name): SUSAN HURST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 623-202-7148
  • Fax:
Mailing address:
  • Phone: 623-202-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number43 430914
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number430914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: