Healthcare Provider Details

I. General information

NPI: 1013557321
Provider Name (Legal Business Name): MAXINE DUBE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STANLEY ST
FALL RIVER MA
02720-6009
US

IV. Provider business mailing address

386 STANLEY ST
FALL RIVER MA
02720-6009
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-1054
  • Fax: 508-324-7777
Mailing address:
  • Phone: 508-675-1054
  • Fax: 508-324-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2297692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: