Healthcare Provider Details

I. General information

NPI: 1144722265
Provider Name (Legal Business Name): JEFFREY S DAUPHINAIS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18341 US HIGHWAY 41
LANSE MI
49946-8024
US

IV. Provider business mailing address

18341 US HIGHWAY 41
LANSE MI
49946-8024
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-6118
  • Fax: 906-524-6218
Mailing address:
  • Phone: 906-524-6118
  • Fax: 906-524-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704261588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: