Provider Demographics
NPI:1073169595
Name:DEFRANCISIS, DUSTIN MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:MICHAEL
Last Name:DEFRANCISIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22681 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-4019
Mailing Address - Country:US
Mailing Address - Phone:814-227-1221
Mailing Address - Fax:
Practice Address - Street 1:22681 ROUTE 68
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-4019
Practice Address - Country:US
Practice Address - Phone:814-227-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant