Healthcare Provider Details

I. General information

NPI: 1477648376
Provider Name (Legal Business Name): JUANITA LOUISE DURHAM A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUANITA LOUISE WOOLLUMS A.R.N.P.

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N 7TH ST
CHARITON IA
50049-1206
US

IV. Provider business mailing address

1030 N 7TH ST PO BOX 674
CHARITON IA
50049-1206
US

V. Phone/Fax

Practice location:
  • Phone: 641-217-9115
  • Fax: 641-217-9137
Mailing address:
  • Phone: 641-217-9115
  • Fax: 641-217-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA089687
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA089687
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: