Healthcare Provider Details

I. General information

NPI: 1760584502
Provider Name (Legal Business Name): VICTORIA TODD DURKEE APRN, PHD, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 DESIARD ST
MONROE LA
71201-7385
US

IV. Provider business mailing address

2211 MALLORY PL
MONROE LA
71201-4509
US

V. Phone/Fax

Practice location:
  • Phone: 318-322-8462
  • Fax: 318-322-8472
Mailing address:
  • Phone: 318-355-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP02630
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: