Healthcare Provider Details

I. General information

NPI: 1942117031
Provider Name (Legal Business Name): DAVID MICHAEL DIPOFI PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E MAIN RD
CONNEAUT OH
44030-9608
US

IV. Provider business mailing address

350 E MAIN RD
CONNEAUT OH
44030-9608
US

V. Phone/Fax

Practice location:
  • Phone: 440-812-4435
  • Fax:
Mailing address:
  • Phone: 440-812-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043080
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: