Provider Demographics
NPI:1922776764
Name:HURLEY, MACKENZIE (CNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:ZANESFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43360-0080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 COPELAND MILL RD STE 1D
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-794-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2023-01-02
Deactivation Date:2022-10-21
Deactivation Code:
Reactivation Date:2022-11-09
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032546363LF0000X
OHRN.458445163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health