Provider Demographics
NPI:1760722342
Name:DURAN, REBECCA (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RED SUN DR # 1D
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7966
Mailing Address - Country:US
Mailing Address - Phone:619-213-8375
Mailing Address - Fax:
Practice Address - Street 1:309 RED SUN DR # 1D
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7966
Practice Address - Country:US
Practice Address - Phone:575-228-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21054363LW0102X
TX1033877363LW0102X
NM65033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21054Medicare UPIN