Provider Demographics
NPI:1275851115
Name:DURKIN, MAUREEN O'CONNOR (RN)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:O'CONNOR
Last Name:DURKIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 BRIXTON PL
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5383
Mailing Address - Country:US
Mailing Address - Phone:678-549-1415
Mailing Address - Fax:
Practice Address - Street 1:3925 JOHNS CREEK CT
Practice Address - Street 2:SUITE A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6618
Practice Address - Country:US
Practice Address - Phone:678-474-4742
Practice Address - Fax:678-474-0095
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-15
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105645163W00000X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163W00000XNursing Service ProvidersRegistered Nurse