Provider Demographics
NPI:1346933215
Name:DURAN, MARTHA ILEANA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ILEANA
Last Name:DURAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 FALLS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7664
Mailing Address - Country:US
Mailing Address - Phone:181-726-6726
Mailing Address - Fax:
Practice Address - Street 1:617 FALLS CREEK CT
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7664
Practice Address - Country:US
Practice Address - Phone:817-266-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111936363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty