Provider Demographics
NPI:1962979104
Name:DUREN, LAVIDA MARIE
Entity type:Individual
Prefix:
First Name:LAVIDA
Middle Name:MARIE
Last Name:DUREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 BENNING RD NE APT A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-7267
Mailing Address - Country:US
Mailing Address - Phone:202-883-0532
Mailing Address - Fax:
Practice Address - Street 1:1734 BENNING RD NE APT A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7267
Practice Address - Country:US
Practice Address - Phone:202-883-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13927374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide