Provider Demographics
NPI:1356497879
Name:DURELL, CATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:
Last Name:DURELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:481 SANDIA LOOP
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-7076
Mailing Address - Country:US
Mailing Address - Phone:505-867-4696
Mailing Address - Fax:505-867-4997
Practice Address - Street 1:203 SANDIA DAY SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-7076
Practice Address - Country:US
Practice Address - Phone:505-867-4696
Practice Address - Fax:505-867-4997
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ4512Medicaid
NMG55810Medicare UPIN