Healthcare Provider Details

I. General information

NPI: 1275634420
Provider Name (Legal Business Name): LORA JEAN HURLBURT R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

3180 CENTER ST NE
SALEM OR
97301-4532
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-2385
  • Fax: 503-371-1635
Mailing address:
  • Phone: 503-581-2385
  • Fax: 503-371-1635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: