Provider Demographics
NPI:1144695479
Name:DURST, RENAI ELIZABETH (PRESIDENT)
Entity type:Individual
Prefix:
First Name:RENAI
Middle Name:ELIZABETH
Last Name:DURST
Suffix:
Gender:F
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13924 E 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:VERADALE
Mailing Address - State:WA
Mailing Address - Zip Code:99037-9125
Mailing Address - Country:US
Mailing Address - Phone:509-951-5482
Mailing Address - Fax:509-891-2342
Practice Address - Street 1:13924 E 32ND AVE
Practice Address - Street 2:
Practice Address - City:VERADALE
Practice Address - State:WA
Practice Address - Zip Code:99037-9125
Practice Address - Country:US
Practice Address - Phone:509-951-5482
Practice Address - Fax:509-891-2342
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFRERERE327DU172A00000X
WARHOADRL256LS172A00000X
WAWHITIS205J3172A00000X
WATRACYK421LD172A00000X
WALINDERT565MU172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver