Provider Demographics
NPI:1891346029
Name:HURLBURT, GAY ELIZABETH (OWNER/OPERATOR)
Entity Type:Individual
Prefix:MRS
First Name:GAY
Middle Name:ELIZABETH
Last Name:HURLBURT
Suffix:
Gender:F
Credentials:OWNER/OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 E PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1514
Mailing Address - Country:US
Mailing Address - Phone:715-672-4049
Mailing Address - Fax:715-672-4247
Practice Address - Street 1:1227 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1514
Practice Address - Country:US
Practice Address - Phone:715-672-4049
Practice Address - Fax:715-672-4247
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-29
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0012349261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care