Provider Demographics
NPI:1689735128
Name:DURBIN, CHRISTINE G (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:G
Last Name:DURBIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65402
Mailing Address - Country:US
Mailing Address - Phone:573-458-8228
Mailing Address - Fax:573-426-5341
Practice Address - Street 1:1000 N. JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MO
Practice Address - Zip Code:65559
Practice Address - Country:US
Practice Address - Phone:573-265-8840
Practice Address - Fax:573-202-2474
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO075771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1689735128Medicaid
MO075771OtherFAMILY NURSE PRACTITIONER
MO154010049Medicare PIN