Basic Information
| Provider Information | |||||||||
| NPI: | 1952688830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAND | ||||||||
| FirstName: | SAMANDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 HARVARD WAY # T5 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895022055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759825262 | ||||||||
| FaxNumber: | 7759824595 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 SIERRA ROSE DR | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759828255 | ||||||||
| FaxNumber: | 7759828251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2011 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | DO1912 | NV | N | Other Service Providers | Acupuncturist | 207R00000X | BP100033437 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS016598 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | P1747 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DO1912 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1952688830 | 05 | NV | MEDICAID | 12580041 | 01 | CAQH | OTHER |