Individual
KEITH M DURYEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNS
Contact information
Practice address
102 N MAGDALEN ST, SAN ANGELO, TX 76903-5400
(325) 658-1511
Mailing address
PO BOX 22000, SAN ANGELO, TX 76902-7200
(325) 658-1511
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
525231
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088296101
—
TX
Enumeration date
02/13/2006
Last updated
05/11/2011
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