Healthcare Provider Details

I. General information

NPI: 1740979053
Provider Name (Legal Business Name): JESSICA S DURAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA S RENTERIA

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

IV. Provider business mailing address

4 BLUEBERRY LN
LOS LUNAS NM
87031-9500
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-2481
  • Fax:
Mailing address:
  • Phone: 505-488-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73278
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: