Healthcare Provider Details

I. General information

NPI: 1285307751
Provider Name (Legal Business Name): KAITLYN MARIE DURINA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PLZ
YOUNGSTOWN OH
44555-0001
US

IV. Provider business mailing address

1120 FOX DEN TRL
CANFIELD OH
44406-8310
US

V. Phone/Fax

Practice location:
  • Phone: 330-941-3000
  • Fax:
Mailing address:
  • Phone: 330-507-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025774
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: