Healthcare Provider Details

I. General information

NPI: 1174923379
Provider Name (Legal Business Name): CONNIE HURLEY DVM, DACVS-SA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE RENEE HURLEY PRITZEL DVM, DACVS-SA

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BLUEMOUND RD
WAUKESHA WI
53188-1752
US

IV. Provider business mailing address

360 BLUEMOUND RD
WAUKESHA WI
53188-1752
US

V. Phone/Fax

Practice location:
  • Phone: 262-542-3241
  • Fax: 262-542-0805
Mailing address:
  • Phone: 262-542-3241
  • Fax: 262-542-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5973-50
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: