Provider Demographics
NPI:1255371241
Name:DUREL, YVETTE PEARSON (CRNA)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:PEARSON
Last Name:DUREL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CHRISTOPHER RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-3213
Mailing Address - Country:US
Mailing Address - Phone:410-879-3585
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR
Practice Address - Street 2:SUITE 20A
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4268
Practice Address - Country:US
Practice Address - Phone:410-420-7630
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120828367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD#S76317Medicare UPIN
MDA091Medicare ID - Type Unspecified