Provider Demographics
NPI:1700139847
Name:HURLBERT, PENNY JEAN (SM SP ED)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:JEAN
Last Name:HURLBERT
Suffix:
Gender:F
Credentials:SM SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13930 W LEE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9327
Mailing Address - Country:US
Mailing Address - Phone:585-590-2378
Mailing Address - Fax:
Practice Address - Street 1:13930 W LEE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9327
Practice Address - Country:US
Practice Address - Phone:585-590-2378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1194746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist