Provider Demographics
NPI:1790442127
Name:DURANT, LUANN ELLEN
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:ELLEN
Last Name:DURANT
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 1:407 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-5415
Mailing Address - Country:US
Mailing Address - Phone:712-251-4873
Mailing Address - Fax:712-224-4302
Practice Address - Street 1:1001 ARBOR DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-2472
Practice Address - Country:US
Practice Address - Phone:402-494-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse