Provider Demographics
NPI:1033693692
Name:HURST, LATOYIA
Entity Type:Individual
Prefix:
First Name:LATOYIA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 N WESTERN AVE UNIT J
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2297
Mailing Address - Country:US
Mailing Address - Phone:920-903-2115
Mailing Address - Fax:
Practice Address - Street 1:337 W WISCONSIN AVE FRNT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4386
Practice Address - Country:US
Practice Address - Phone:920-903-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies