Provider Demographics
NPI:1841203627
Name:DURKOVIC, JAMIE MICHELLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MICHELLE
Last Name:DURKOVIC
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:JOHANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8501 CHASE GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3307
Mailing Address - Country:US
Mailing Address - Phone:703-690-5260
Mailing Address - Fax:703-690-5260
Practice Address - Street 1:8501 CHASE GLEN CIR
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-3307
Practice Address - Country:US
Practice Address - Phone:703-690-5260
Practice Address - Fax:703-690-5260
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2005080170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS