Provider Demographics
NPI:1205962818
Name:HURLEY, ELIZABETH ANN (CO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:HURLEY
Suffix:
Gender:F
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RIVER ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9033
Mailing Address - Country:US
Mailing Address - Phone:307-752-6915
Mailing Address - Fax:866-535-0635
Practice Address - Street 1:3553 CASTRO VALLEY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4400
Practice Address - Country:US
Practice Address - Phone:307-752-6915
Practice Address - Fax:866-535-0635
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist