MEDICARE: SIARAH SIMONE DURHAM CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	00785108	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	493745576	OTHER		PASSPORT

General Provider Information

NPI Number	:	1306313135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIARAH SIMONE DURHAM CNA

Provider Business Mailing Address
First Line	:	2366 S DILLON ST
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-2418
Country	:	US
Telephone Number	:	720-588-5947
Fax Number	:

Provider Business Practice Location Address
First Line	:	2366 S DILLON STREET
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-8001
Country	:	US
Telephone Number	:	720-588-5947
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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