Provider Demographics
NPI:1568244135
Name:HURTUK, MIKENNA
Entity Type:Individual
Prefix:
First Name:MIKENNA
Middle Name:
Last Name:HURTUK
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 1:98 LOWER WESTFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2744
Mailing Address - Country:US
Mailing Address - Phone:132-828-6364
Mailing Address - Fax:
Practice Address - Street 1:98 LOWER WESTFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2744
Practice Address - Country:US
Practice Address - Phone:132-828-6364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker