Provider Demographics
NPI:1881119246
Name:HURLEY, AMANDA LYNN (CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
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 1:03920 SOUTHLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEW BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:45869-9790
Mailing Address - Country:US
Mailing Address - Phone:419-629-2772
Mailing Address - Fax:419-629-3613
Practice Address - Street 1:03920 SOUTHLAND RD
Practice Address - Street 2:
Practice Address - City:NEW BREMEN
Practice Address - State:OH
Practice Address - Zip Code:45869-9790
Practice Address - Country:US
Practice Address - Phone:419-629-2772
Practice Address - Fax:419-629-3613
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.021382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily