Provider Demographics
NPI:1144312422
Name:DUPLAIN, MICHELLE A (PA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:DUPLAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SHELBY AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-9597
Mailing Address - Country:US
Mailing Address - Phone:330-704-8909
Mailing Address - Fax:
Practice Address - Street 1:110 AUBURN AVE
Practice Address - Street 2:STE 2
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1104
Practice Address - Country:US
Practice Address - Phone:419-342-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1053333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant