Healthcare Provider Details

I. General information

NPI: 1760722342
Provider Name (Legal Business Name): REBECCA DURAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 RED SUN DR # 1D
CHAPARRAL NM
88081-7966
US

IV. Provider business mailing address

309 RED SUN DR # 1D
CHAPARRAL NM
88081-7966
US

V. Phone/Fax

Practice location:
  • Phone: 575-228-7787
  • Fax:
Mailing address:
  • Phone: 619-213-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number21054
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1033877
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number65033
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: