Provider Demographics
NPI:1609173780
Name:DUREN, SARA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:MICHELLE
Last Name:DUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 GLAVERA AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2530
Mailing Address - Country:US
Mailing Address - Phone:330-704-9537
Mailing Address - Fax:
Practice Address - Street 1:128 GLAVERA AVE N.E.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-2530
Practice Address - Country:US
Practice Address - Phone:330-704-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN140392164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse