Healthcare Provider Details

I. General information

NPI: 1457763898
Provider Name (Legal Business Name): SUZANNE L DUPONT APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S MORRISON ST
APPLETON WI
54911-5725
US

IV. Provider business mailing address

229 S MORRISON ST
APPLETON WI
54911-5725
US

V. Phone/Fax

Practice location:
  • Phone: 920-832-2783
  • Fax: 920-832-2797
Mailing address:
  • Phone: 920-832-2783
  • Fax: 920-832-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number109248-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6359-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: