Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 26NJ00835900 | NJ |
NPI | 1003390766 |
---|---|
Provider Name | Ali Michelle Durino |
First Address | Hardwick, NJ 07825-9531 |
Second Address | Hardwick, NJ 07825-9531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 19/09/2018 |