Provider Demographics
NPI:1346994902
Name:DURRANT, IKEA (CNA LPN)
Entity Type:Individual
Prefix:
First Name:IKEA
Middle Name:
Last Name:DURRANT
Suffix:
Gender:F
Credentials:CNA LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-3118
Mailing Address - Country:US
Mailing Address - Phone:716-578-3801
Mailing Address - Fax:
Practice Address - Street 1:182 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3118
Practice Address - Country:US
Practice Address - Phone:716-578-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343782570216E171W00000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No171W00000XOther Service ProvidersContractor
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY343782570216EOtherCNA