Healthcare Provider Details

I. General information

NPI: 1548698715
Provider Name (Legal Business Name): NICOLE REGINA DURHAM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S GEORGE ST
YORK PA
17401-1474
US

IV. Provider business mailing address

116 S GEORGE ST
YORK PA
17401-1474
US

V. Phone/Fax

Practice location:
  • Phone: 717-845-8617
  • Fax:
Mailing address:
  • Phone: 717-845-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP013310
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: