Provider Demographics
NPI:1700447273
Name:DURANDISSE, KRIS
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:DURANDISSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3591 NW 83RD LN
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6738
Mailing Address - Country:US
Mailing Address - Phone:954-459-5019
Mailing Address - Fax:
Practice Address - Street 1:3591 NW 83RD LN
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6738
Practice Address - Country:US
Practice Address - Phone:954-459-5019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide