Provider Demographics
NPI:1407175292
Name:DURHAM, DONNA M (NNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:DURHAM
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:DURHAM-ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP
Mailing Address - Street 1:1613 N. HARRISON PARKWAY
Mailing Address - Street 2:SUITE 200, MAILSTOP SH-9A
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2371
Mailing Address - Fax:954-851-1746
Practice Address - Street 1:1613 N. HARRISON PARKWAY
Practice Address - Street 2:STE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2896
Practice Address - Country:US
Practice Address - Phone:954-838-2371
Practice Address - Fax:954-851-1746
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1179692363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal