Provider Demographics
NPI:1225208002
Name:DURHMAN, SHAUNA J
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:J
Last Name:DURHMAN
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 1:1211 FULTON ST
Mailing Address - Street 2:APT #1
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3321
Mailing Address - Country:US
Mailing Address - Phone:612-270-0342
Mailing Address - Fax:
Practice Address - Street 1:1211 FULTON ST
Practice Address - Street 2:APT #1
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3321
Practice Address - Country:US
Practice Address - Phone:612-270-0342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07192171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor