Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | F02180493 | IN |
NPI | 1013486588 |
---|---|
Provider Name | Rebekah Hurst |
First Address | Lafayette, IN 47904-2138 |
Second Address | Lafayette, IN 47904-2971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300021784 | (05) | IN |