Healthcare Provider Details

I. General information

NPI: 1245380179
Provider Name (Legal Business Name): GERRI ANN DURAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N 2ND ST
GRANTS NM
87020-2507
US

IV. Provider business mailing address

4920 CALLE DE TIERRA NE
ALBUQUERQUE NM
87111-2927
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-2844
  • Fax: 505-237-2020
Mailing address:
  • Phone: 505-299-2844
  • Fax: 505-237-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number72
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: