Healthcare Provider Details

I. General information

NPI: 1427709229
Provider Name (Legal Business Name): SYDNAE COLLYN HURLBUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 COUNTY ROAD 91
BELLEFONTAINE OH
43311-9007
US

IV. Provider business mailing address

112 E MAIN ST
BELLE CENTER OH
43310-9751
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-2901
  • Fax:
Mailing address:
  • Phone: 937-844-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLPN.174177.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: