Healthcare Provider Details

I. General information

NPI: 1629585153
Provider Name (Legal Business Name): JUSTINE C DURU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2568
  • Fax: 855-903-0985
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2026015192
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number931712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: