Provider Demographics
NPI:1902983083
Name:HURD, ANGIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:HURD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:BREWSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2617 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8271
Mailing Address - Country:US
Mailing Address - Phone:540-953-2210
Mailing Address - Fax:
Practice Address - Street 1:2617 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8271
Practice Address - Country:US
Practice Address - Phone:540-953-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001990OtherSTATE LICENSE
WV31651Medicare PIN