Healthcare Provider Details

I. General information

NPI: 1043022031
Provider Name (Legal Business Name): MAVOLYN JONES HURT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 01/25/2025
Certification Date: 01/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

5109 SUMMER GARDEN PL
SUFFOLK VA
23434-8449
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4588
  • Fax:
Mailing address:
  • Phone: 757-403-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001086714
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: