Provider Demographics
NPI:1427709229
Name:HURLBUT, SYDNAE COLLYN
Entity type:Individual
Prefix:
First Name:SYDNAE
Middle Name:COLLYN
Last Name:HURLBUT
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 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43310-9751
Mailing Address - Country:US
Mailing Address - Phone:937-844-9868
Mailing Address - Fax:
Practice Address - Street 1:2739 COUNTY ROAD 91
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9007
Practice Address - Country:US
Practice Address - Phone:937-592-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.174177.MEDS-IV164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse