Healthcare Provider Details

I. General information

NPI: 1881672988
Provider Name (Legal Business Name): PATTI L. DUPREY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PORTLAND ROAD SUITE 5
KENNEBUNK ME
04043
US

IV. Provider business mailing address

57 PORTLAND ROAD SUITE 5
KENNEBUNK ME
04043-6031
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-3777
  • Fax: 888-312-0662
Mailing address:
  • Phone: 207-467-3777
  • Fax: 888-312-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number032355-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP121019
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: