MEDICARE: MS. SHIRLEY ANN HURLEY

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	172A00000X	Driver	H64078060753	IL

General Provider Information

NPI Number	:	1659812782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY ANN HURLEY

Provider Business Mailing Address
First Line	:	6817 N RIDGE BLVD
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60645-4916
Country	:	US
Telephone Number	:	773-962-8538
Fax Number	:

Provider Business Practice Location Address
First Line	:	6817 N RIDGE BLVD APT 2
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60645-4916
Country	:	US
Telephone Number	:	773-962-8538
Fax Number	:

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

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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