Healthcare Provider Details

I. General information

NPI: 1558955492
Provider Name (Legal Business Name): JILL HURSHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 COURT ST S
RIPLEY WV
25271-1408
US

IV. Provider business mailing address

PO BOX 617
RIPLEY WV
25271-0617
US

V. Phone/Fax

Practice location:
  • Phone: 304-372-2406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: