Doctor Name: | MS. JUANITA SCHMITT DURHAM |
NPI Number: | 1255649737 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 001405 |
Business Practice Address: | 201 W Main St Niantic, CT - 063571014 |
Business Phone Number: | 8606916856 |
Business Fax Number: | 8606916900 |
Mailing Address: | 201 W Main St, NIANTIC |
State: | CT |
Postal Code: | 063571014 |
Phone Number: | 8606916856 |
Fax Number: | 8606916900 |
NPI Enumeration Date: | 09/19/2010 |
NPI Last Update Date: | 09/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 001405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |