MEDICARE: DESERIE DIANE HURT CERTIFIED DOULA

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	374J00000X	Doula		OH

General Provider Information

NPI Number	:	1073367561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESERIE DIANE HURT CERTIFIED DOULA

Provider Business Mailing Address
First Line	:	12600 ROCKSIDE RD # 300
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-714-3347
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 ROCKSIDE RD # 300
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-714-3347
Fax Number	:

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

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	03/12/2026

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