Healthcare Provider Details

I. General information

NPI: 1811448335
Provider Name (Legal Business Name): ANDRE WILLIAM DAUPHINAIS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BERKEY LN
SOMERSET PA
15501-2502
US

IV. Provider business mailing address

615 BERKEY LN
SOMERSET PA
15501-2502
US

V. Phone/Fax

Practice location:
  • Phone: 814-442-5871
  • Fax:
Mailing address:
  • Phone: 814-442-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN662900
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: