Healthcare Provider Details

I. General information

NPI: 1730699265
Provider Name (Legal Business Name): DAWN MARIE HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 GEORGETOWN ST
LOUISVILLE OH
44641-9676
US

IV. Provider business mailing address

9894 GEORGETOWN ST
LOUISVILLE OH
44641-9676
US

V. Phone/Fax

Practice location:
  • Phone: 330-581-9376
  • Fax:
Mailing address:
  • Phone: 330-581-9376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number141423
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: