Provider Demographics
NPI:1720642879
Name:HURTT, CARLISA JEAN
Entity Type:Individual
Prefix:MRS
First Name:CARLISA
Middle Name:JEAN
Last Name:HURTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14501 OWINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5915
Mailing Address - Country:US
Mailing Address - Phone:301-875-4921
Mailing Address - Fax:
Practice Address - Street 1:14501 OWINGS AVE
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5915
Practice Address - Country:US
Practice Address - Phone:301-875-4921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula