Provider Demographics
NPI:1649776048
Name:DURANTE, LAUREN (MS LAT ATC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DURANTE
Suffix:
Gender:F
Credentials:MS LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 WILLOW PASS
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-2247
Mailing Address - Country:US
Mailing Address - Phone:630-272-1148
Mailing Address - Fax:
Practice Address - Street 1:4652 WILLOW PASS
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-2247
Practice Address - Country:US
Practice Address - Phone:630-272-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1584-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer