Provider Demographics
NPI:1134862360
Name:DUARTE, ANA BRENDA (LPN)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:BRENDA
Last Name:DUARTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4522 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-5339
Mailing Address - Country:US
Mailing Address - Phone:928-285-3704
Mailing Address - Fax:
Practice Address - Street 1:75 N GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-3805
Practice Address - Country:US
Practice Address - Phone:520-459-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ272175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse