Provider Demographics
NPI:1598380131
Name:HURKS, JANICE LEESHAL
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:LEESHAL
Last Name:HURKS
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 1:9051 MANSFIELD RD STE E3
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2680
Mailing Address - Country:US
Mailing Address - Phone:318-505-9505
Mailing Address - Fax:318-716-3378
Practice Address - Street 1:9051 MANSFIELD RD STE E3
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2680
Practice Address - Country:US
Practice Address - Phone:318-505-9505
Practice Address - Fax:318-716-3378
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator