Provider Demographics
NPI:1144486457
Name:DUPONT, AMY (CNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28502 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-4576
Mailing Address - Country:US
Mailing Address - Phone:440-312-9041
Mailing Address - Fax:
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5260
Practice Address - Country:US
Practice Address - Phone:440-312-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN290032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse