Healthcare Provider Details

I. General information

NPI: 1982018875
Provider Name (Legal Business Name): CYNTHIA LYNN DUPUIS-GIBSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

IV. Provider business mailing address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

V. Phone/Fax

Practice location:
  • Phone: 413-348-6349
  • Fax: 413-746-3110
Mailing address:
  • Phone: 413-348-6349
  • Fax: 413-746-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN229325
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: