Healthcare Provider Details

I. General information

NPI: 1518686971
Provider Name (Legal Business Name): ASHLEE SUZANNE DURAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 S SAN FRANCISCO ST
FLAGSTAFF AZ
86001
US

IV. Provider business mailing address

3218 W COOPER DR
FLAGSTAFF AZ
86001-1006
US

V. Phone/Fax

Practice location:
  • Phone: 928-523-2131
  • Fax:
Mailing address:
  • Phone: 928-642-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number279785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: