Provider Demographics
NPI:1760006399
Name:DURDEN, CRYSTAL (RN)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:DURDEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 LANEY WALKER BLVD PAVILION II; AF 1040
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-9745
Mailing Address - Fax:
Practice Address - Street 1:1465 LANEY WALKER BLVD PAVILION II; AF 1040
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-9745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC224126163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health