Provider Demographics
NPI:1912312208
Name:HURT, CHAUNTE (LPN)
Entity Type:Individual
Prefix:
First Name:CHAUNTE
Middle Name:
Last Name:HURT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13855 SUPERIOR RD
Mailing Address - Street 2:1303
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1079
Mailing Address - Country:US
Mailing Address - Phone:440-381-9648
Mailing Address - Fax:
Practice Address - Street 1:13855 SUPERIOR RD
Practice Address - Street 2:1303
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1079
Practice Address - Country:US
Practice Address - Phone:440-381-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse