Healthcare Provider Details

I. General information

NPI: 1043918667
Provider Name (Legal Business Name): JAMIE LYNN HURLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 TOWPATH LN
WATERFORD NY
12188-4006
US

IV. Provider business mailing address

120 LANCASTER ST APT 1
COHOES NY
12047-4319
US

V. Phone/Fax

Practice location:
  • Phone: 518-596-0017
  • Fax:
Mailing address:
  • Phone: 518-879-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number320520
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: