Healthcare Provider Details

I. General information

NPI: 1730897810
Provider Name (Legal Business Name): ALEXANDRA LOUISE HURLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20886 RIVERSIDE DR
GRUNDY VA
24614-9597
US

IV. Provider business mailing address

20886 RIVERSIDE DR
GRUNDY VA
24614-9597
US

V. Phone/Fax

Practice location:
  • Phone: 276-935-7515
  • Fax: 276-935-4351
Mailing address:
  • Phone: 276-935-7515
  • Fax: 276-935-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185360
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: