Healthcare Provider Details

I. General information

NPI: 1598291353
Provider Name (Legal Business Name): JULIO RENE DURAN JR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 CEDAR ST
NEW BRITAIN CT
06052-1301
US

IV. Provider business mailing address

77 HAZARD AVE UNIT M2
ENFIELD CT
06082-3890
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5267
  • Fax: 860-224-5752
Mailing address:
  • Phone: 860-966-1004
  • Fax: 860-788-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number7027
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: