Basic Information
| Provider Information | |||||||||
| NPI: | 1639591142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURAN | ||||||||
| FirstName: | ELAIZA | ||||||||
| MiddleName: | JAZMYN | ||||||||
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| Credential: | RN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3768 | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953443768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097257149 | ||||||||
| FaxNumber: | 2097260134 | ||||||||
| Practice Location | |||||||||
| Address1: | 19901 1ST ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | HILMAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953249099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2096568701 | ||||||||
| FaxNumber: | 2096568704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2014 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95003483 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.