Healthcare Provider Details

I. General information

NPI: 1336710367
Provider Name (Legal Business Name): AMANDA G DURBIN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/03/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N7, CORNER OF ROUTES N12
FORT DEFIANCE AZ
86504
US

IV. Provider business mailing address

2315 TOMPIRO DR NW
ALBUQUERQUE NM
87120-1377
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax:
Mailing address:
  • Phone: 870-378-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRCP-4258
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP-4258
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: