Provider Demographics
NPI:1659642114
Name:DURHAM, EDITHA ALICIA
Entity Type:Individual
Prefix:MS
First Name:EDITHA
Middle Name:ALICIA
Last Name:DURHAM
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 1:11954 230TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2212
Mailing Address - Country:US
Mailing Address - Phone:718-949-7809
Mailing Address - Fax:718-949-7809
Practice Address - Street 1:11954 230TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-2212
Practice Address - Country:US
Practice Address - Phone:718-949-7809
Practice Address - Fax:718-949-7809
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY375213163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse