Provider Demographics
NPI:1114950193
Name:HURTT, BRENDA JOYCE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:HURTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JOYCE
Other - Last Name:MARKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5441
Mailing Address - Country:US
Mailing Address - Phone:507-333-3300
Mailing Address - Fax:507-333-3214
Practice Address - Street 1:924 1ST ST NE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5441
Practice Address - Country:US
Practice Address - Phone:507-333-3300
Practice Address - Fax:507-333-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080176220OtherRAIL ROAD MEDICARE
MN333317500Medicaid
MN333317500Medicaid
MN080010675Medicare ID - Type Unspecified
G08465Medicare UPIN