Provider Demographics
NPI:1679928071
Name:HURST, DANIELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5355 RIVER RD N
Mailing Address - Street 2:107
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:503-999-0628
Mailing Address - Fax:
Practice Address - Street 1:5355 RIVER RD N
Practice Address - Street 2:107
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-8300
Practice Address - Country:US
Practice Address - Phone:503-999-0628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other