Provider Demographics
NPI:1811224512
Name:HURDER, KENNETH H
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:HURDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1340
Mailing Address - Country:US
Mailing Address - Phone:317-849-4615
Mailing Address - Fax:317-849-9758
Practice Address - Street 1:8702 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1340
Practice Address - Country:US
Practice Address - Phone:317-849-4615
Practice Address - Fax:317-849-9758
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27037482A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse