Provider Demographics
NPI:1457564015
Name:DURAN, SELENA
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:
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:PO BOX 67
Mailing Address - Street 2:5 MILES WEST OF WHITECONE HIGH SCHOOL
Mailing Address - City:KEAMS CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:86034-0067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 MILES WEST OF WHITECONE HIGH SCHOOL ROUTE 77
Practice Address - Street 2:
Practice Address - City:KEAMS CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86034
Practice Address - Country:US
Practice Address - Phone:928-797-5941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Not Answered376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ090787OtherSTATE PROVIDER ID