Healthcare Provider Details

I. General information

NPI: 1518298413
Provider Name (Legal Business Name): NICOLE MARIE DURIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

IV. Provider business mailing address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-9513
  • Fax: 859-277-6063
Mailing address:
  • Phone: 859-278-9513
  • Fax: 859-277-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number252748
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number58811
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: