Provider Demographics
NPI:1801675194
Name:RUSTY RIVERA DURAN NP-C LLC
Entity type:Organization
Organization Name:RUSTY RIVERA DURAN NP-C LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:513-504-0458
Mailing Address - Street 1:205 HAMPTON HWY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3512
Mailing Address - Country:US
Mailing Address - Phone:757-865-1843
Mailing Address - Fax:757-865-7485
Practice Address - Street 1:205 HAMPTON HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3512
Practice Address - Country:US
Practice Address - Phone:757-865-1843
Practice Address - Fax:757-865-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty