MEDICARE: MS. MICHELE KATHARINE HURLBUT MS, RN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704302858	MI
2	363LF0000X	Family Nurse Practitioner	4704302858	MI
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704302858	MI

General Provider Information

NPI Number	:	1043677370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE KATHARINE HURLBUT MS, RN, FNP-BC

Provider Business Mailing Address
First Line	:	5123 W ST JOE HWY STE 205
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-492-0611
Fax Number	:	517-492-0699

Provider Business Practice Location Address
First Line	:	5123 W ST JOE HWY STE 205
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4028
Country	:	US
Telephone Number	:	517-492-0611
Fax Number	:	517-492-0699

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	03/21/2025

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