Provider Demographics
NPI:1700456993
Name:DURAN, TERESA G (RN)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:G
Last Name:DURAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 KAHLSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-9726
Mailing Address - Country:US
Mailing Address - Phone:707-298-8955
Mailing Address - Fax:
Practice Address - Street 1:770 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6210
Practice Address - Country:US
Practice Address - Phone:707-826-8610
Practice Address - Fax:707-826-8623
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse