Healthcare Provider Details

I. General information

NPI: 1619534492
Provider Name (Legal Business Name): CHRISTINE HURST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 E PERSHING BLVD
CHEYENNE WY
82001-5356
US

IV. Provider business mailing address

1345 S GROWERS DR
MILLIKEN CO
80543-8473
US

V. Phone/Fax

Practice location:
  • Phone: 307-778-7550
  • Fax:
Mailing address:
  • Phone: 812-767-1756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number28179422A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number1635450
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: