Healthcare Provider Details

I. General information

NPI: 1265044093
Provider Name (Legal Business Name): MICHELLE LYNN HURST CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1597 MEDICAL DR
POTTSTOWN PA
19464-3224
US

IV. Provider business mailing address

PO BOX 22573
NEW YORK NY
10087-2573
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-6732
  • Fax:
Mailing address:
  • Phone: 856-669-6050
  • Fax: 856-528-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP022376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: