Healthcare Provider Details

I. General information

NPI: 1407175292
Provider Name (Legal Business Name): DONNA M. DURHAM NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA M. DURHAM-ALVAREZ NNP

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N. HARRISON PARKWAY STE 200
SUNRISE FL
33323-2896
US

IV. Provider business mailing address

1613 N. HARRISON PARKWAY SUITE 200, MAILSTOP SH-9A
SUNRISE FL
33323-2896
US

V. Phone/Fax

Practice location:
  • Phone: 954-838-2371
  • Fax: 954-851-1746
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP1179692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: