Provider Demographics
NPI:1841025343
Name:DURHAM, KRYSTAL T
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:T
Last Name:DURHAM
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 1:528 50TH PL NE APT 12
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5408
Mailing Address - Country:US
Mailing Address - Phone:202-381-4852
Mailing Address - Fax:
Practice Address - Street 1:528 50TH PL NE APT 12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5408
Practice Address - Country:US
Practice Address - Phone:202-381-4852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant