Healthcare Provider Details

I. General information

NPI: 1417132259
Provider Name (Legal Business Name): IRINA DAUPHINEE PMHNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WEBSTER ST STE 8
HANOVER MA
02339-1227
US

IV. Provider business mailing address

425 LAKE AVE N STE 101
WORCESTER MA
01605-2073
US

V. Phone/Fax

Practice location:
  • Phone: 781-754-6545
  • Fax:
Mailing address:
  • Phone: 508-753-3220
  • Fax: 508-753-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN268466
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN268466
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: