=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699281527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEJANDRA DURAN CRT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2017
-----------------------------------------------------
Last Update Date | 06/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8736 OGDEN AVE
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60534-1060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-442-9800
-----------------------------------------------------
Fax | 708-442-9889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8736 OGDEN AVE
-----------------------------------------------------
City | LYONS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60534-1060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-442-9800
-----------------------------------------------------
Fax | 708-442-9889
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 194.010723
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------