Provider Demographics
NPI:1730897067
Name:DURETT, DONALD LEE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
Last Name:DURETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 FIELDBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9465
Mailing Address - Country:US
Mailing Address - Phone:530-588-6602
Mailing Address - Fax:
Practice Address - Street 1:3641 FIELDBROOK AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9465
Practice Address - Country:US
Practice Address - Phone:530-588-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10000113163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse