Healthcare Provider Details

I. General information

NPI: 1700456993
Provider Name (Legal Business Name): TERESA G DURAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 10TH ST
ARCATA CA
95521-6210
US

IV. Provider business mailing address

833 KAHLSTROM AVE
TRINIDAD CA
95570-9726
US

V. Phone/Fax

Practice location:
  • Phone: 707-826-8610
  • Fax: 707-826-8623
Mailing address:
  • Phone: 707-298-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: