Provider Demographics
NPI:1578326765
Name:DURHAM, ISABEL GRACE (PA-S)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:GRACE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 KATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-2702
Mailing Address - Country:US
Mailing Address - Phone:186-423-8563
Mailing Address - Fax:
Practice Address - Street 1:310 KATHERINE ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2702
Practice Address - Country:US
Practice Address - Phone:186-423-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant