Healthcare Provider Details

I. General information

NPI: 1568859783
Provider Name (Legal Business Name): MRS. HEATHER DUPREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2015
Last Update Date: 04/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 ROSS RD
KENNEBUNK ME
04043-6532
US

IV. Provider business mailing address

40 NEW RD
HOLLIS CENTER ME
04042-3737
US

V. Phone/Fax

Practice location:
  • Phone: 207-590-9449
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT2285
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0
Identifier TypeOTHER
Identifier State
Identifier IssuerO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: