1760584502 NPI number — DR. VICTORIA TODD DURKEE APRN, PHD, CNS

Table of content: DR. MICHAEL L SPINNER PHARMD (NPI 1124603147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760584502 NPI number — DR. VICTORIA TODD DURKEE APRN, PHD, CNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURKEE
Provider First Name:
VICTORIA
Provider Middle Name:
TODD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
APRN, PHD, CNS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760584502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 MALLORY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-355-6559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 DESIARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-7385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-322-8462
Provider Business Practice Location Address Fax Number:
318-322-8472
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  AP02630 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN061503 . This is a "RN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: AP02630 . This is a "APRN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: R544868 . This is a "RN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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