Healthcare Provider Details

I. General information

NPI: 1881172179
Provider Name (Legal Business Name): STEPHANIE NICHOLE HURLEY CMA, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 BURNET AVE
CINCINNATI OH
45219-2419
US

IV. Provider business mailing address

17 HELENA ST
BATESVILLE IN
47006-1401
US

V. Phone/Fax

Practice location:
  • Phone: 513-872-8870
  • Fax:
Mailing address:
  • Phone: 812-527-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberL9M6E8N3
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: