Provider Demographics
NPI:1306313135
Name:DURHAM, SIARAH SIMONE (CNA)
Entity type:Individual
Prefix:
First Name:SIARAH
Middle Name:SIMONE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 S DILLON ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2418
Mailing Address - Country:US
Mailing Address - Phone:720-588-5947
Mailing Address - Fax:
Practice Address - Street 1:2366 S DILLON STREET
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-8001
Practice Address - Country:US
Practice Address - Phone:720-588-5947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00785108374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
493745576OtherPASSPORT