Provider Demographics
NPI:1265887319
Name:HURST, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:RAE
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, AGACNP-C
Mailing Address - Street 1:436 S 750 E
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5661
Mailing Address - Country:US
Mailing Address - Phone:208-431-1144
Mailing Address - Fax:
Practice Address - Street 1:1700 OVERLAND AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-2436
Practice Address - Country:US
Practice Address - Phone:208-825-6193
Practice Address - Fax:208-825-6199
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-20719363L00000X
ID53805363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner