Healthcare Provider Details

I. General information

NPI: 1427172980
Provider Name (Legal Business Name): LYNETTE M DUPEE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 ULALI DR NE
KEIZER OR
97303-1500
US

IV. Provider business mailing address

7920 NW CANYON DR
CORVALLIS OR
97330-2739
US

V. Phone/Fax

Practice location:
  • Phone: 503-361-5400
  • Fax:
Mailing address:
  • Phone: 541-758-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00596
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: