Provider Demographics
NPI:1093317141
Name:SUBBA, DURGA MAYA
Entity Type:Individual
Prefix:
First Name:DURGA
Middle Name:MAYA
Last Name:SUBBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 9TH AVE S APT 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2000
Mailing Address - Country:US
Mailing Address - Phone:701-317-8178
Mailing Address - Fax:
Practice Address - Street 1:4301 9TH AVE S APT 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2000
Practice Address - Country:US
Practice Address - Phone:701-317-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant