Basic Information
| Provider Information | |||||||||
| NPI: | 1144722265 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAUPHINAIS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18341 US HIGHWAY 41 | ||||||||
| Address2: | |||||||||
| City: | LANSE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499468024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9065246118 | ||||||||
| FaxNumber: | 9065246218 | ||||||||
| Practice Location | |||||||||
| Address1: | 18341 US HIGHWAY 41 | ||||||||
| Address2: | |||||||||
| City: | LANSE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499468024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9065246118 | ||||||||
| FaxNumber: | 9065246218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2018 | ||||||||
| LastUpdateDate: | 03/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704261588 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4704261588 | 01 | MI | NURSING LICENSE-NP | OTHER |