Provider Demographics
NPI:1215578711
Name:HURN, PATSY E
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:E
Last Name:HURN
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 1:21659A SONGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5615
Mailing Address - Country:US
Mailing Address - Phone:907-373-1000
Mailing Address - Fax:888-588-5194
Practice Address - Street 1:21659A SONGBIRD DR
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5615
Practice Address - Country:US
Practice Address - Phone:907-373-1000
Practice Address - Fax:888-588-5194
Is Sole Proprietor?:No
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12345171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK12345Medicaid