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NPI Code Detail

MEDICARE: MICHELE Y. HURSH NP

MEDICARE: MICHELE Y. HURSH NP
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
1363L00000XNurse Practitioner4704255526MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295984359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE Y. HURSH NP
Provider Business Mailing Address
First Line : 69405 CHRISTIANA LAKE ROAD
Second Line :
City : EDWARDSBURG
State : MI
Zip : 49112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4368 CLEVELAND AVE
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9595
Country : US
Telephone Number : 270-983-6501
Fax Number : 269-983-2237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2008
Last Update Date : 07/13/2017

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