Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R 203782 2 | MN |
NPI | 1033470638 |
---|---|
Provider Name | Karla Lynn Hurtley |
First Address | Saint Paul, MN 55106-2615 |
Second Address | St Paul, MN 55102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2012 |
Last Update Date | 27/06/2018 |