Healthcare Provider Details

I. General information

NPI: 1912312208
Provider Name (Legal Business Name): CHAUNTE HURT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13855 SUPERIOR RD 1303
CLEVELAND OH
44118-1079
US

IV. Provider business mailing address

13855 SUPERIOR RD 1303
CLEVELAND OH
44118-1079
US

V. Phone/Fax

Practice location:
  • Phone: 440-381-9648
  • Fax:
Mailing address:
  • Phone: 440-381-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number155497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: