Provider Demographics
NPI:1508132333
Name:HURLEY, LISA GAY (NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAY
Last Name:HURLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:GAY
Other - Last Name:CROASDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:826 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2120
Mailing Address - Country:US
Mailing Address - Phone:989-729-4977
Mailing Address - Fax:989-729-4062
Practice Address - Street 1:826 W KING ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2120
Practice Address - Country:US
Practice Address - Phone:989-729-4977
Practice Address - Fax:989-729-4062
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704225641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily