Provider Demographics
NPI:1730843889
Name:DUERSON, KWAJALIEN U S
Entity type:Individual
Prefix:
First Name:KWAJALIEN
Middle Name:U S
Last Name:DUERSON
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 1:7241 BIGTOOTH MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9497
Mailing Address - Country:US
Mailing Address - Phone:719-761-3349
Mailing Address - Fax:
Practice Address - Street 1:7241 BIGTOOTH MAPLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80925-9497
Practice Address - Country:US
Practice Address - Phone:719-761-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program