Healthcare Provider Details

I. General information

NPI: 1861104770
Provider Name (Legal Business Name): STEPHANIE HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 MAIN ST
CHAPMANVILLE WV WV
25508-2550
US

IV. Provider business mailing address

PO BOX 4304
CHAPMANVILLE WV
25508-4304
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-4764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106025
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: