Provider Demographics
NPI:1891113247
Name:DURHAM, TRISHA (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2932
Mailing Address - Country:US
Mailing Address - Phone:773-960-9108
Mailing Address - Fax:
Practice Address - Street 1:7830 W 151ST ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2932
Practice Address - Country:US
Practice Address - Phone:773-960-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041374812163W00000X
IL209011492363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse