Healthcare Provider Details

I. General information

NPI: 1891113387
Provider Name (Legal Business Name): MICHAELLE DUBUISSON MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHAELLE VINCENT MSN, APRN, FNP-C

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 FRENCH RD STE 103
NEW HARTFORD NY
13413-1070
US

IV. Provider business mailing address

555 FRENCH RD STE 103
NEW HARTFORD NY
13413-1070
US

V. Phone/Fax

Practice location:
  • Phone: 937-866-1821
  • Fax: 937-866-1821
Mailing address:
  • Phone: 315-735-9785
  • Fax: 315-724-3255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025702
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345400-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: