Healthcare Provider Details

I. General information

NPI: 1033754296
Provider Name (Legal Business Name): TERRY DURAN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15515 JUANITA WOODINVILLE WAY NE
BOTHELL WA
98011-1576
US

IV. Provider business mailing address

15515 JUANITA WOODINVILLE WAY NE UNIT N301
BOTHELL WA
98011-6111
US

V. Phone/Fax

Practice location:
  • Phone: 425-298-5278
  • Fax:
Mailing address:
  • Phone: 425-298-5278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61376797
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: