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General NPI Number Information
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NPI Number | 1447743406
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Entity Type | Individual
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Provider Name | JENNIFER L DUPPERT PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 30 WARREN ST
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City | BRIGHTON
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State | MA
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Zip | 02135-3602
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Country | US
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Telephone | 315-450-1362
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Fax | 617-779-1482
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Provider Business Mailing Address
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Address Line | 223 PALMER DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1244
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Country | US
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Telephone | 315-450-1362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 402392
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License Number State | NY
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