Provider Demographics
NPI:1114416179
Name:HURLEY, DEVON ELIZABETH
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:ELIZABETH
Last Name:HURLEY
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 1:1424 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2208
Mailing Address - Country:US
Mailing Address - Phone:215-514-6658
Mailing Address - Fax:267-455-0825
Practice Address - Street 1:1512 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1636
Practice Address - Country:US
Practice Address - Phone:267-239-5637
Practice Address - Fax:267-455-0825
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006063133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered