MEDICARE: MRS. MYRLANDE DUBUISSON CPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1812982	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942317227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MYRLANDE DUBUISSON CPN

Provider Business Mailing Address
First Line	:	4100 SW 143RD AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-3049
Country	:	US
Telephone Number	:	954-431-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	16161 NW 57TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-6707
Country	:	US
Telephone Number	:	305-625-3409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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