Healthcare Provider Details

I. General information

NPI: 1821905704
Provider Name (Legal Business Name): EBONIE DURHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W PLEASANT ST
MILWAUKEE WI
53212-3941
US

IV. Provider business mailing address

3934 W CLYBOURN ST
MILWAUKEE WI
53208-3757
US

V. Phone/Fax

Practice location:
  • Phone: 414-874-5220
  • Fax:
Mailing address:
  • Phone: 414-803-3702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number16448730
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: