Provider Demographics
NPI:1093041808
Name:DURAND, VANESSA NICOLLETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:NICOLLETTE
Last Name:DURAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CHURCH ST
Mailing Address - Street 2:APT 5B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4521
Mailing Address - Country:US
Mailing Address - Phone:818-264-6693
Mailing Address - Fax:
Practice Address - Street 1:1802 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3420
Practice Address - Country:US
Practice Address - Phone:302-655-5822
Practice Address - Fax:302-225-2725
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0010132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics