Healthcare Provider Details

I. General information

NPI: 1528537750
Provider Name (Legal Business Name): ALEXANDER DUPUIS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

IV. Provider business mailing address

212 W SUPERSTITION BLVD STE 101
APACHE JUNCTION AZ
85120-4127
US

V. Phone/Fax

Practice location:
  • Phone: 480-877-0120
  • Fax: 888-498-4092
Mailing address:
  • Phone: 480-877-0120
  • Fax: 888-498-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219369
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: