Provider Demographics
NPI:1225836661
Name:DURRANT, MACEY MARIAH
Entity type:Individual
Prefix:
First Name:MACEY
Middle Name:MARIAH
Last Name:DURRANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5077 S SANDPIPER DR APT 562
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4712
Mailing Address - Country:US
Mailing Address - Phone:763-221-8373
Mailing Address - Fax:
Practice Address - Street 1:5077 S SANDPIPER DR APT 562
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4712
Practice Address - Country:US
Practice Address - Phone:763-221-8373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program