Provider Demographics
NPI:1548708837
Name:HURT, REBA SUE (RN)
Entity type:Individual
Prefix:
First Name:REBA
Middle Name:SUE
Last Name:HURT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5177 E 545
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-1140
Mailing Address - Country:US
Mailing Address - Phone:918-698-4307
Mailing Address - Fax:918-434-1903
Practice Address - Street 1:900 N OWEN WALTERS BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:OK
Practice Address - Zip Code:74365-0490
Practice Address - Country:US
Practice Address - Phone:918-434-8500
Practice Address - Fax:918-434-1903
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0050389163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health