Provider Demographics
NPI:1790148476
Name:DURBIN, JOHANNE (PA-C)
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:DURBIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2219
Mailing Address - Country:US
Mailing Address - Phone:804-249-8888
Mailing Address - Fax:804-249-7246
Practice Address - Street 1:5901 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2219
Practice Address - Country:US
Practice Address - Phone:804-249-8888
Practice Address - Fax:804-249-7246
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1790148476Medicaid