Healthcare Provider Details

I. General information

NPI: 1093302275
Provider Name (Legal Business Name): MARIE ELIZABETH HURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W BURKE ST
MARTINSBURG WV
25401-2709
US

IV. Provider business mailing address

20 CREEDMORE DR
BUNKER HILL WV
25413-4330
US

V. Phone/Fax

Practice location:
  • Phone: 304-901-5172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: