Provider Demographics
NPI:1427225457
Name:HURLBUTT, JENNIFER MARY (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:HURLBUTT
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 TONGASS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6013
Mailing Address - Country:US
Mailing Address - Phone:907-220-9447
Mailing Address - Fax:907-220-9884
Practice Address - Street 1:1621 TONGASS AVE STE 207
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6072
Practice Address - Country:US
Practice Address - Phone:907-220-9447
Practice Address - Fax:907-220-9884
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1202363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0178Medicaid