Provider Demographics
NPI:1982974382
Name:DURANTE, LEA SIMS (FNP)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:SIMS
Last Name:DURANTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:SIMS
Other - Last Name:ROSEMURGY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6413
Mailing Address - Country:US
Mailing Address - Phone:707-252-0494
Mailing Address - Fax:
Practice Address - Street 1:1001 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6413
Practice Address - Country:US
Practice Address - Phone:707-252-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21246363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17770669715Medicaid