Provider Demographics
NPI:1912519794
Name:HURLEY, VANESSA SUE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:SUE
Last Name:HURLEY
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 1:993 ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:MATEWAN
Mailing Address - State:WV
Mailing Address - Zip Code:25678-7836
Mailing Address - Country:US
Mailing Address - Phone:606-525-9535
Mailing Address - Fax:
Practice Address - Street 1:993 ROUTE 49
Practice Address - Street 2:
Practice Address - City:MATEWAN
Practice Address - State:WV
Practice Address - Zip Code:25678-7836
Practice Address - Country:US
Practice Address - Phone:606-525-9535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant