Basic Information
| Provider Information | |||||||||
| NPI: | 1932597507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURT | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | LU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 13TH AVE W | ||||||||
| Address2: | STE 1 | ||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586014879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012277500 | ||||||||
| FaxNumber: | 7012277575 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 13TH AVE W | ||||||||
| Address2: | STE 1 | ||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586014879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012277500 | ||||||||
| FaxNumber: | 7012277575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2015 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.