Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 263306 | AZ |
NPI | 1073281069 |
---|---|
Provider Name | Virginia Durrett |
First Address | Kingman, AZ 86401-2306 |
Second Address | Kingman, AZ 86401-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |