Healthcare Provider Details

I. General information

NPI: 1245928613
Provider Name (Legal Business Name): NICOLE HURLEY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MINOR AVE STE 230
SEATTLE WA
98104-2133
US

IV. Provider business mailing address

272 SE ORCHARD DR APT 3
NORTH BEND WA
98045-5028
US

V. Phone/Fax

Practice location:
  • Phone: 206-539-0675
  • Fax: 206-339-1449
Mailing address:
  • Phone: 360-941-6687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61424464
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: