Provider Demographics
NPI:1922888023
Name:DURAN, PAULINE ANNE
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:ANNE
Last Name:DURAN
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 1:8349 RESEDA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5913
Mailing Address - Country:US
Mailing Address - Phone:818-928-0004
Mailing Address - Fax:
Practice Address - Street 1:8349 RESEDA BLVD STE F
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5913
Practice Address - Country:US
Practice Address - Phone:818-688-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026176363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology