Healthcare Provider Details

I. General information

NPI: 1265624688
Provider Name (Legal Business Name): JUDITH HURLBURT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6128 E 38TH ST STE 305
TULSA OK
74135-5814
US

IV. Provider business mailing address

6128 E 38TH ST STE 305
TULSA OK
74135-5814
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7404
  • Fax: 918-584-2530
Mailing address:
  • Phone: 918-599-7404
  • Fax: 918-584-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR0054933
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: