Healthcare Provider Details

I. General information

NPI: 1669771481
Provider Name (Legal Business Name): CANDACE-DAWN V HURLEY RN, APRN, FNP-C,NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE HURLEY RN, APRN, FNP-C,NP-C

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

615 MILLARD DR
BAY VILLAGE OH
44140-1958
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-229-2338
Mailing address:
  • Phone: 216-791-3800
  • Fax: 216-229-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.334616
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.17221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: