Provider Demographics
NPI:1215061064
Name:DURBIN, NANCY CHARLENE (PROVIDER)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CHARLENE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:MR
Other - First Name:JERALD
Other - Middle Name:LEE
Other - Last Name:DURBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PROVIDER
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:AGRA
Mailing Address - State:OK
Mailing Address - Zip Code:74824-0285
Mailing Address - Country:US
Mailing Address - Phone:918-375-2648
Mailing Address - Fax:918-375-2648
Practice Address - Street 1:501 EAST LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:AGRA
Practice Address - State:OK
Practice Address - Zip Code:74824-0285
Practice Address - Country:US
Practice Address - Phone:918-375-2648
Practice Address - Fax:918-375-2648
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging