=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710804141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM GRANT HURLEY APN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2026
-----------------------------------------------------
Last Update Date | 07/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 COUNTY ROAD 14
-----------------------------------------------------
City | DEL NORTE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81132-8758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-657-2510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189 HIDDEN VIEW DR
-----------------------------------------------------
City | SOUTH FORK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81154-9781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-849-8069
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APN.1002079-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APN.1002079-NP
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------