Healthcare Provider Details

I. General information

NPI: 1891346029
Provider Name (Legal Business Name): GAY ELIZABETH HURLBURT OWNER/OPERATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2019
Last Update Date: 09/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E PROSPECT ST
DURAND WI
54736-1514
US

IV. Provider business mailing address

1227 E PROSPECT ST
DURAND WI
54736-1514
US

V. Phone/Fax

Practice location:
  • Phone: 715-672-4049
  • Fax: 715-672-4247
Mailing address:
  • Phone: 715-672-4049
  • Fax: 715-672-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0012349
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: