Provider Demographics
NPI:1174295026
Name:HURSEY, RAMONA
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:
Last Name:HURSEY
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 1:2011 MORELAND BLVD UNIT 205
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1435
Mailing Address - Country:US
Mailing Address - Phone:217-390-1794
Mailing Address - Fax:
Practice Address - Street 1:3008 W DANIEL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4054
Practice Address - Country:US
Practice Address - Phone:217-390-1794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center