Healthcare Provider Details

I. General information

NPI: 1356928881
Provider Name (Legal Business Name): ELIZABETH HARE HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/27/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR
CHARLESTON SC
29425-3099
US

IV. Provider business mailing address

25 COURTENAY DR
CHARLESTON SC
29425-8911
US

V. Phone/Fax

Practice location:
  • Phone: 919-880-4460
  • Fax:
Mailing address:
  • Phone: 873-792-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number25031
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: