Healthcare Provider Details

I. General information

NPI: 1962620443
Provider Name (Legal Business Name): MRS. JOAN ELAIN HURSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 BARTLEY AVE
MANSFIELD OH
44903
US

IV. Provider business mailing address

7184 TOWNSHIP ROAD 49
LEXINGTON OH
44904
US

V. Phone/Fax

Practice location:
  • Phone: 419-747-4702
  • Fax:
Mailing address:
  • Phone: 419-362-5712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: